Dosage Forms. Tablet: 1 mg, 2 mg; Capsule, Extended Release: 2 mg, 4 mg
Common FDA Label Indication, Dosing, and Titration.
1. Bladder muscle dysfunction—overactive: Immediate release, 1-2 mg po bid; Extended release, 2-4 mg po daily; may titrate dose to tolerability and response
Off-Label Uses. None
MOA. Tolterodine, a competitive muscarinic receptor antagonist, has a high binding affinity for the cholinergic muscarinic receptors that mediates contraction of the urinary bladder and enhances salivation. The drug exerts its significant effects on the lower urinary tract by increasing the residual urine and decreasing detrusor pressure. It has a low affinity for other neurotransmitter receptors and other possible targets like calcium channels.
Drug Characteristics: Tolterodine
Medication Safety Issues: Tolterodine
Drug Interactions: Tolterodine
Adverse Reactions: Tolterodine
Efficacy Monitoring Parameters. Subjective improvement of urge incontinence (reduced desire to urinate), and urinary frequency.
Toxicity Monitoring Parameters. Monitor vital signs.
Key Patient Counseling Points. Patients should avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause blurred vision, dizziness, and drowsiness. Swallow extended-release capsule whole; do not crush, break, or chew. Take with 8 ounces of water or other liquid. In the presence of a high environmental temperature, heat prostration can occur with drug use (fever and heat stroke due to decreased sweating). If symptoms occur, the drug should be discontinued and supportive measures instituted.
Clinical Pearls. May note decline in cognitive function, particularly in elderly. Lifestyle changes can also improve urinary symptoms. Patients should lose weight and avoid beverages containing alcohol or caffeine. Long-acting product is generally better tolerated.