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February 9, 2012

tolterodine, Detrol, Detrol LA

GENERIC NAME: tolterodine

BRAND NAME: Detrol, Detrol LA

DRUG CLASS AND MECHANISM: Tolterodine belongs to a class of drugs called cholinergic (acetyl-choline) receptor blockers. It is used to treat disorders of the urinary bladder that affect urination.

The urinary bladder is a muscular "bag." Urine coming from the kidneys fills the bladder and causes it to stretch like a balloon. As it stretches, pressure in the bladder increases and, when the bladder reaches a certain level of stretch, a desire to urinate is felt. Nerves in the muscular wall of the bladder release acetyl- choline, a chemical that attaches to receptors on the muscle cells and causes the cells to contract (tighten). This contributes further to the increase in pressure within the bladder and the desire to urinate. At the appropriate time (e.g., when a toilet is available), there is conscious relaxation of the muscle at the outlet of the bladder, and the high bladder pressure forces urine out of the bladder. Normally, urination is under conscious control; however, in some individuals normal control as well as normal sensation are lost. The desire to urinate may be felt when there is little urine in the bladder, and urination may occur without warning or control. By blocking the effect of acetyl-choline on the muscle cells, tolterodine slows the build-up of pressure in the bladder, reduces the sensation to urinate, and prevents uncontrolled urination. The FDA approved tolterodine in 1998. An extended release form of tolterodine, (Detrol LA) was approved by the FDA in 2001.

GENERIC AVAILABLE: no

PRESCRIPTION: yes

PREPARATIONS: Tolterodine tablets: 1mg and 2mg. Long acting tolterodine capsules: 2mg and 4 mg.

STORAGE: Tablets and capsules should be stored at room temperature, 15- 30°C (59-86°F).

PRESCRIBED FOR: Tolterodine is used to treat uncontrollable urination due to what is often referred to as an "overactive" bladder. Symptoms include the need to urinate frequently, an urge to urinate immediately, and an inability to control urine release (urinary incontinence).

DOSING: Tolterodine usually is taken twice daily. The starting dose is 2mg twice daily. With the long-acting tolterodine, the starting dose is 4mg daily, and may be reduced to 2mg if the larger dose is not tolerated. The dose may need to be reduced for patients who have impaired function of the liver or kidneys. Caution is recommended for patients with narrow-angle glaucoma, obstruction to the flow of urine, or poor emptying of the stomach since these medical conditions may worsen with tolterodine administration.

DRUG INTERACTIONS: Tolterodine follows a specific path through the liver in order to be eliminated from the body. Drugs that block this path may slow the elimination of tolterodine, raise tolterodine blood levels, and lead to side effects. No formal studies have been conducted showing such interactions, however. The list of drugs that might possibly interfere with the elimination of tolterodine includes is erythromycin, clarithromycin (Biaxin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Monistat, Micatin). The dose of tolterodine should be reduced to 1mg twice daily if taken with any of these drugs.

PREGNANCY: At doses much greater than those used in humans, tolterodine causes fetal abnormalities in animals. There are no studies with tolterodine in pregnant women. Therefore, tolterodine should only be given to pregnant women if the benefits are felt to outweigh the potential risks.

NURSING MOTHERS: Tolterodine is secreted into breast milk in animals; however, it is not known if tolterodine is secreted into the breast milk of women. Therefore, its use is not recommended in nursing mothers.

SIDE EFFECTS: The most common side effects seen while taking tolterodine are dry mouth, dry eyes, headache, upset stomach and constipation. Tolterodine also may cause blurred vision.

Reference: FDA Prescribing Information


Last Editorial Review: 11/15/2001




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Suggested Reading on tolterodine, Detrol, Detrol LA by Our Doctors

  • Related Diseases & Conditions

    • Overactive Bladder
      • Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
    • Urinary Incontinence
      • There are many types of urinary incontinence (UI), which is the accidental leakage of urine. These types include stress incontinence, urge incontinence, and overflow incontinence. Urinary incontinence in men may be caused by prostate or nerve problems. Treatment depends upon the type and severity of the UI and the patient's lifestyle.
    • Urinary Retention
      • Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
    • Bladder Spasms
      • People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
    • Nerve Disease and Bladder Control
      • A nerve problem might affect your bladder control if the nerves that are supposed to carry messages between the brain and the bladder do not work properly. Such problems include urine retention, poor control of sphincter muscles, and overactive bladder. Treatment depends upon the cause of the nerve damage and resulting type of bladder control problem.
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tolterodine, Detrol, Detrol LA

What bladder control problems does nerve damage cause?

Nerves that work poorly can lead to three different kinds of bladder control problems.

Nerves carry signals from the brain to the bladder and sphincter.

Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include

  • urinary frequency -- defined as urination eight or more times a day or two or more times at night
  • urinary urgency -- the sudden, strong need to urinate immediately
  • urge incontinence -- leakage of urine that follows a sudden, strong urge to urinate

Poor control of...

Read the Nerve Disease and Bladder Control article »







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