BMA Concise Guide to Medicine & Drugs

Tolterodine

Brand names Detrusitol, Detrusitol XL

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for urinary disorders

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Tolterodine is an anticholinergic and antispasmodic drug that is similar to atropine. It is used to treat urinary frequency and incontinence in adults. It works by reducing contraction of the bladder, allowing it to expand and hold more. It also stops spasms and delays the desire to empty the bladder. Tolterodine’s usefulness is limited to some extent by its side effects, and dosage needs to be reduced in the elderly. Children are more susceptible than adults to the drug’s anticholinergic effects. Tolterodine can also trigger glaucoma.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR capsules.

Frequency and timing of doses 1–2 x daily.

Dosage range 4mg daily, reduced to 2mg daily, if necessary, to minimize side effects.

Onset of effect 1 hour.

Duration of action 12 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor; symptoms may recur.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if symptoms such as breathing difficulty, seizures, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Many of tolterodine’s common side effects are the result of its anticholinergic action. Dry mouth, digestive upset, constipation, abdominal pain, dry eyes, blurred vision, drowsiness, nervousness, and chest pain are common adverse effects. Discuss with your doctor if you experience chest pain or if any of the other common effects are severe. Less commonly, the drug may cause confusion or urinary difficulties; consult your doctor if these occur. If you have an unexplained collapse, stop taking the drug and seek urgent medical help.

INTERACTIONS

General note All drugs that have an anticholinergic effect will have increased side effects when taken with tolterodine.

Domperidone and metoclopramide The effects of these drugs may be decreased by tolterodine.

Erythromycin, clarithromycin, itraconazole, ketoconazole, and miconazole These drugs may increase blood levels of tolterodine.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You have thyroid problems.

· You have heart problems, especially rhythm disturbances.

· You have hiatus hernia.

· You have prostate problems or urinary retention.

· You have ulcerative colitis.

· You have glaucoma.

· You have myasthenia gravis.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. May harm the unborn baby. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended. Safety not established.

Over 60 No special problems.

Driving and hazardous work Avoid. Tolterodine may cause drowsiness, disorientation, and blurred vision.

Alcohol Avoid. Alcohol increases the drug’s sedative effects.

PROLONGED USE

No special problems. Effectiveness of the drug, and continuing clinical need for it, are usually reviewed after 3–6 months.

Monitoring Periodic eye tests for glaucoma may be performed.