Tolterodine (Oral)

Tolterodine is used to treat the symptoms caused by an overactive bladder, including the need to urinate frequently and leakage.

Overview

Urinary incontinence can significantly reduce your quality of life. As people get older they are more likely to suffer from incontinence, but it also affects younger people, for example, some mothers after childbirth, and children.

The urge to pass water, also known as urinary frequency, is triggered by muscles spasms in the bladder. Tolterodine is an antispasmodic medication, which has the effect of decreasing the contractions of the muscles of the bladder and therefore reducing the need to urinate so often.

Tolterodine is designed to relax the detrusor muscle in the bladder wall. The way it does this is by blocking the action of the muscarinic (or cholinergic) receptors located in the surface of the muscle wall cells. When these receptors are blocked, they cannot respond to the chemical acetylcholine which is produced naturally in the body, and which normally causes the bladder's detrusor muscle to contract. With receptors blocked, the involuntary contractions of the bladder are reduced, and the bladder is able to hold more urine. The urge to pass urine is therefore reduced.

Conditions treated

  • Urinary incontinence
  • Urinary frequency
  • Urinary urgency

Type of medicine

  • Anticholinergic
  • Antimuscarinic
  • Antispasmodic

Tolterodine is sold as a generic medicine and under brand names, including Detrol and Detrutisol. It is available in both immediate and prolonged release versions. The active ingredient in the medication is Tolterodine tartrate, an antimuscarinic muscle relaxant.

Side effects

Bladder problems can be embarrassing or inconvenient, and, in more severe cases, debilitating. Tolterodine can enhance everyday life for many people, but, as with many forms of medication, it can also have some side effects.

When you first begin taking Tolterodine, it is advisable to avoid activities which could put your health or safety at risk if certain side effects happen to present themselves. For example, if you operate machinery, or drive long distances, you should arrange to stop doing this temporarily until you have discovered whether Tolterodine causes drowsiness or blurred vision for you as a side effect.

Your doctor will be able to give you advice on how to manage some of the less severe side effects. For example, if you experience giddiness or the sensation of spinning, your doctor may recommend simple techniques, such as getting up from a chair or bed more slowly to avoid aggravating the light-headedness.

Allergic reaction

In some people, an allergic reaction may occur when they begin a course of Tolterodine treatment. If you have experienced an allergic reaction previously to other medications you should inform your doctor, and also mention any other allergies you have, for example allergies to foods or preservatives. Serious types of allergic reaction which can be triggered by Tolterodine include anaphylaxis and angioedema. These conditions can be life-threatening and require urgent medical assistance.

If you experience any of the following symptoms, you should stop taking the medication and contact your doctor or other medical professional immediately:

  • Difficulty breathing
  • Difficulty swallowing
  • Fainting
  • Hives symptoms: swelling of eyelids, lips, throat, tongue, hands, feet, legs, genitalia
  • Hallucinations
  • Hoarseness
  • Lightheadedness
  • Skin rash with itching
  • Severe fatigue

Common side effects include:

  • Bronchial secretions reduced
  • Constipation
  • Dilation of pupils and loss of accommodation (ability to focus on changing distances)
  • Drowsiness
  • Dry mouth
  • Joint pain
  • Skin flushing
  • Stomach ache
  • Transient bradycardia (with possible tachycardia, palpitation and arrhythmias)
  • Urinary retention
  • Urinary urgency

One of the more common side effects of antimuscarinic medication is a dry mouth. Although Tolterodine is significantly less likely to cause dry mouth than some alternative medicines, such as oxybutynin, you may still experience it. If you do have dry mouth, you can alleviate it by using a saliva substitute, melting small pieces of ice in your mouth, or chewing gum. Dry mouth can lead to other complications, and should not be ignored. You should speak to your doctor if the condition lasts for more than two weeks. If you have ongoing dryness in the mouth there is an increased risk of your developing fungal infections, gum disease and tooth decay.

Less common side effects include:

  • Anxiety
  • Belching
  • Blurred vision
  • Confusion - most common in children or the elderly
  • Difficulty moving
  • Dry skin
  • Giddiness
  • Heartburn
  • Indigestion
  • Mood swings
  • Nausea
  • Severe drowsiness
  • Vomiting
  • Weight gain or loss

Extremely rare side effects

Angle-closure glaucoma (rapid rise in fluid pressure in the eye) - this requires urgent medical attention to avoid damage to or loss of vision

Other side effects, with frequency not recorded:

  • Central nervous system stimulation
  • Convulsion
  • Diarrhoea
  • Disorientation
  • Dizziness
  • Dry eyes
  • Flatulence
  • Headache
  • Impaired memory
  • Micturition disorders (difficulty urinating)
  • Palpitation
  • Photosensitivity
  • Rash
  • Reduced sweating (can cause fainting)
  • Restlessness
  • Taste impairment

Dosage

Tolterodine is available in the following formats:

  • Capsule (extended release)
  • Tablet

The dosage will vary according to your individual needs. Average doses are as follows:

Tolterodine tablets

  • Adults: 2 milligrams twice a day, on average
  • Children: a child's dosage will be determined by his or her doctor.

Tolterodine extended release capsules

  • Adults: 4 milligrams once a day
  • Children: not usually recommended for children; a doctor will prescribe the correct level of medication required if it is deemed appropriate

If you are taking extended or controlled release capsules, swallow one whole with water. It is very important to make sure you don't pierce, crush or chew the capsules. They must be swallowed whole or there is a risk that too much of the medication will be released into your system immediately. The extended release capsules are designed to allow the medication to filter into your bloodstream gradually, and it may be harmful to you if this process is not followed.

You should always follow the precise dosage instructions from your doctor. If your doctor has not given you separate instructions, follow the dosage advice on the label and the patient information insert. Tolterodine may be taken with or without food. It should be swallowed with a full glass of water, and taken at the same time every day. If you miss a dose, you can take the missed tablet or capsule as soon as possible afterwards. However, if it is nearly time for your next dose, do not double up and take the forgotten tablet or capsule as well. Instead, simply skip the forgotten dose, and move onto the next dose. If you exceed your prescribed dosage it will increase your risk of serious side effects and you should seek professional medical advice immediately. Your local healthcare centre will be able to advise you how to dispose of any unneeded medicine once you have completed the course of treatment.

Tolterodine can take several weeks to make an improvement to your condition. You should continue to take the medicine as prescribed by your doctor even if you see no immediate change. Do not increase the dosage. You should have a review with your doctor, which will provide an opportunity for your dosage to be re-assessed.

Your doctor will monitor your health regularly when you start a course of treatment with Tolterodine, as there is a small risk of an allergic reaction to this medication. Your doctor will also want to monitor the impact of any other side effects. If you are unfortunate enough to experience some of the more uncommon but more harmful side effects, your doctor may recommend an alternative medicine for you. Your doctor may also review periodically whether you still need to continue to take Tolterodine.

Tolterodine is sold under the brand names Detrol and Detrusitol and is available on prescription only.

Interactions

It is recommended that the following medications should not be used in conjunction with Tolterodine:

  • Amifampridine
  • Amisulpride
  • Bepridil
  • Cisapride
  • Dronedarone
  • Mesoridazine
  • Pimozide
  • Piperaquine
  • Potassium
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

In most cases Tolterodine will not be recommended for use with the following medicines:

  • Amiodarone
  • Anagrelide
  • Arsenic Trioxide
  • Bupropion
  • Buserelin
  • Clarithromycin
  • Crizotinib
  • Dabrafenib
  • Degarelix
  • Delamanid
  • Deslorelin
  • Domperidone
  • Donepezil
  • Efavirenz
  • Escitalopram
  • Fluoxetine
  • Gonadorelin
  • Goserelin
  • Histrelin
  • Hydroxychloroquine
  • Hydroxyzine
  • Ivabradine
  • Ketoconazole
  • Leuprolide
  • Levofloxacin
  • Metronidazole
  • Moxifloxacin
  • Nafarelin
  • Ondansetron
  • Oxymorphone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Pimavanserin
  • Pitolisant
  • Quetiapine
  • Sevoflurane
  • Sotalol
  • Sulpride
  • Tacrolimus
  • Tiotropium
  • Triptorelin
  • Vandetanib
  • Vemurafenib
  • Vinflunine
  • Zuclopenthixol

There are also some medicines which, in conjunction with Tolterodine, may increase the likelihood of side effects occurring. These include:

  • Cyclosporine
  • Erythromycin
  • Galantamine
  • Itraconazole
  • Miconazole
  • Propafenone
  • Quinidine
  • Rivastigmine
  • Vinblastine
  • Warfarin

Over the counter medicines, herbal remedies and vitamin supplements can all interact with Tolterodine. Always check with your doctor whether it is safe for you to take other medications and health products while you are using Tolterodine.

You may also need to avoid certain types of food when you are taking Tolterodine. Your doctor will advise you if there are any dietary restrictions and if you need to avoid tobacco or alcohol.

Paying attention to some areas of your diet can also help your bladder condition. For example, reducing your consumption of caffeinated soft drinks and tea can help. This is because caffeine acts as a diuretic, and will increase your urge to urinate.

Warnings

Tolterodine can produce an allergic reaction in some people, and you should seek urgent medical advice if you experience symptoms, as detailed under side effects above.

There are several contraindications for Tolterodine. It should be avoided for people who are currently experiencing or have a history of:

  • Bladder outflow obstruction (severe)
  • Enlarged prostate
  • Gastro-intestinal obstruction
  • Intestinal atony
  • Myasthenia gravis
  • Paralytic ileus
  • Pyloric stenosis
  • Toxic megacolon
  • Ulcerative colitis (severe)
  • Urinary retention

You should alert your doctor if you have any of the following conditions, so that he or she can assess whether Tolterodine is the most suitable medication for you:

  • Glaucoma
  • Hiatus hernia
  • Kidney disease
  • Liver disease
  • Low levels of electrolytes in the blood, e.g. calcium, magnesium or potassium

You must also inform your doctor if you or anyone in your close family has a history of prolonged QT interval in ECG tests.

Pregnancy

Tolterodine should be avoided in pregnancy. Although there have not been adequate studies to determine human reaction, animal studies demonstrate toxicity. You should inform your doctor if you become pregnant while you are being treated with Tolterodine.

Breastfeeding

Studies are not available to demonstrate whether this medication may or may not be harmful to the infant if taken by a breastfeeding mother. It is not known whether Tolterodine passes into breastmilk. Therefore, Tolterodine is generally not recommended for use by mothers who are breastfeeding. If you suffer from an overactive bladder while you are nursing a baby, you and your doctor will need to consider the potential risks and benefits for your particular condition, and assess whether Tolterodine is the most suitable choice for you.

Children

Studies have not identified specific issues with giving Tolterodine to children. Tolterodine is occasionally prescribed for children over the age of five years, who have problems with bedwetting.

Elderly

Tolterodine is not known to have specific issues for elderly patients. However, dosage would need to be considered with caution for patients who have age-related decreased liver or kidney function.

Storage

Tolterodine should be kept in an airtight container to avoid contact with moisture. Store Tolterodine out of direct light, at room temperature, away from heat sources and certainly above freezing. As with all medicines, make sure you keep it out of reach of children. Do not use medicine with an expired use by date. Dispose of any unneeded medicine in accordance with your healthcare centre's guidelines.

Summary

Urinary incontinence can be both inconvenient and embarrassing to anyone experiencing it. In more severe cases it can even make people feel house-bound. Tolterodine helps to alleviate the symptoms of urinary incontinence, such as leakage, urinary urgency and needing to urinate frequently.

Tolterodine will provide relief to many patients, but for others it may not be suitable due to pre-existing conditions, such as kidney or liver problems. If you are prescribed Tolterodine, you should make sure that you have informed the doctor if you have any such conditions. This is particularly important if you are having treatment from a doctor other than your usual doctor.

Tolterodine does not combine well with some other medications. In some cases, the combination of Tolterodine and another medicine could significantly increase the likelihood of your experiencing severe side effects. Your doctor may choose to change your existing medication, so that you can take Tolterodine, or may recommend an alternative medicine to treat your bladder problems.

You may experience side effects while taking Tolterodine. In some cases the side effects may pass, but you should always seek advice from your doctor. Drowsiness may occur in patients taking Tolterodine, so you should establish whether this affects you before doing anything which could be dangerous if you are drowsy. Occasionally Tolterodine can cause an allergic reaction in a patient. If you have symptoms such as difficulty breathing or swallowing, hallucinations or swelling, you must get urgent medical assistance.

There are two versions of Tolterodine - immediate release tablets, usually taken twice a day, and extended or prolonged release capsules, taken once daily. It is essential that prolonged release tablets are swallowed whole, undamaged and not chewed, so that the medicine reaches the bloodstream gradually through the day, as intended. Always follow your doctor's exact instructions for taking Tolterodine, and if you experience any difficulties, report them to your doctor right away.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
Content Source: