Index
We are talking about a drug generally used to treat enuresis and overactive bladder.
Tolterodine (brand names Detrol, Detrusitol) is an antimuscarinic drug used for the symptomatic treatment of urinary incontinence.
Pfizer marketed it in Canada and the United States under the brand name Detrol. In Egypt, it is also found under the trade names Tolterodine for Sabaa and Incont LA for Adwia.
Uses of Detrol
Detrusor overactivity (OD, contraction of the muscular bladder wall) is the most common form of urinary incontinence (UI) in older adults. It is characterized by uninhibited bladder contractions that cause an uncontrollable urge to void.
Urodynamic studies can measure abnormal bladder contractions that coincide with the need to empty.
Treatment is bladder retraining, pelvic floor therapy, or medications that inhibit bladder contractions, such as oxybutynin and Tolterodine.
By relaxing your bladder muscles, Tolterodine improves your ability to control urination. It helps reduce urine leakage, the feeling of needing to urinate right away, and frequent trips to the bathroom. This medication belongs to the class of drugs known as antispasmodics.
Detrol Pharmacology
Tolterodine acts on muscarinic receptor subtypes M2 and M3, whereas older antimuscarinic treatments for overactive bladder act more specifically on M3 receptors.
Although acting on all types of receptors, Tolterodine has fewer side effects than oxybutynin (selective M3 and M1, but more in the parotid than in the bladder) since tolterodine targets the bladder more than other areas of the body. Body.
This means that less medication needs to be given daily (due to effective bladder targeting), and therefore there are fewer side effects.
How does this medication work? What will you do for me?
Tolterodine belongs to a group of medicines known as anticholinergics. It is used to treat people with an overactive bladder who have symptoms including frequent urination, urgency, or involuntary loss of urine.
Tolterodine helps these symptoms by preventing bladder contractions or spasms.
Symptom relief may not be seen until about two weeks after starting tolterodine treatment, and improvement is seen after eight weeks.
In what form (s) does this medication come?
1 mg
Each white, round, biconvex film-coated tablet, debossed with arcs above and below the letters ‘Too,’ contains Tolterodine L-tartrate 1 mg.
2 mg
Each white, round, biconvex film-coated tablet debossed with arcs above and below the letters ‘DT’ contains Tolterodine L-tartrate 2 mg.
Non-medicinal ingredients
Calcium hydrogen phosphate dihydrate, microcrystalline cellulose, colloidal anhydrous silica, hypromellose, magnesium stearate, sodium starch glycolate (pH 3.0-5.0), stearic acid, and titanium dioxide.
Storage
- Keep in a room at room temperature, away from light and moisture.
- Do not store it in the bathroom.
- Properly dispose of this product when it is expired or no longer needed.
- Consult your pharmacist or local waste disposal company.
How should I use this medicine?
The recommended adult starting dose of Tolterodine is 2 mg twice daily, with or without food. The amount can be reduced to 1 mg twice daily, depending on the response and individual needs.
For people with reduced liver or kidney function and taking certain medications, the recommended dose is 1 mg twice a day. Check with your doctor or pharmacist.
It is essential to take this medicine regularly and exactly as prescribed by your doctor. To help you remember, use it at the same time every day.
The dose is based on your medical condition (especially kidney and liver disease), response to treatment, and other medications you may be taking.
Do not increase your dose or take this medicine more often than directed. Your condition will not improve any faster, and your risk of severe side effects may increase.
Overdose symptoms may include fast/slow/irregular heartbeat, fainting, unusual excitement, and mental / mood changes.
Precautions with the first or subsequent doses
Controlled narrow-angle glaucoma, liver or kidney failure, anaphylaxis, and angioedema requiring hospitalization and emergency treatment; discontinue immediately if angioedema and hypotension, shortness of breath, or airway obstruction develop.
Use caution in patients with myasthenia gravis, characterized by decreased cholinergic activity at the neuromuscular junction.
When co-administered with potent CYP3A4 inhibitors, Tolterodine should be administered in reduced doses.
Who should NOT take this medicine?
Tolterodine should not be used by anyone who:
- You are allergic to Tolterodine or any of the ingredients in the medicine.
- You have gastric retention (stomach obstruction).
- You have uncontrolled narrow-angle glaucoma.
- You have urinary retention.
QTc prolongation is reported with high doses; use caution in patients with prolonged congenital QT or in patients receiving concurrent therapy with drugs that prolong QTc (class Ia or III antiarrhythmics).
Anticholinergics can adversely affect the clinical course of Alzheimer’s disease in patients receiving cholinesterase inhibitors.
To monitor declines in cognition, functional abilities, and increases in problem behaviors in dementia patients receiving dual therapy with an anticholinesterase inhibitor and a bladder anticholinergic agent such as Tolterodine.
It can increase the risk of urinary retention in patients with obstruction of bladder flow (such as benign prostatic hypertrophy).
It may increase the risk of gastric retention in patients with decreased gastrointestinal (GI) motility or obstructive gastrointestinal disorders.
What side are effects possible with Detrol?
Tell your doctor right away if you have serious side effects, such as severe stomach / abdominal pain, trouble urinating, or signs of kidney infection (such as burning / painful urination, lower back pain, fever).
Seek medical attention immediately if you have serious side effects such as fast/slow/irregular heartbeat, severe dizziness, or fainting.
- Constipation.
- Dizziness.
- Dry eyes.
- Dry mouth.
- Fatigue.
- Gas.
- Headache.
- Acidity.
- Vision changes, including difficulty adjusting to distances.
Check with your doctor as soon as possible if any of the following side effects occur:
- Bloody or cloudy urine.
- Difficult, burning, or painful urination.
- Swelling of the lower legs.
However, seek medical attention immediately if you notice any symptoms of a severe allergic reaction, such as rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or difficulty breathing.
Stop taking this medicine and seek immediate medical attention if any of the following occur:
Chest pain, symptoms of an abnormal heart rhythm, such as dizziness, palpitations (fast, pounding, or irregular heartbeats), fainting, or seizures. Signs of an allergic reaction (such as difficulty breathing, hives, swelling of the face or throat).
Some people may experience side effects other than those listed. This is not a complete list of possible side effects. Contact your doctor or pharmacist if you notice other effects not listed above.
Are there any other precautions or warnings for this drug?
Before using this medicine, tell your doctor or pharmacist your medical history, especially of:
- Problems emptying the bladder (urinary retention, bladder flow obstruction), severe stomach / bowel obstruction (gastric retention), glaucoma, stomach / intestinal disease (such as ulcerative colitis, slow stomach / bowel movement).
- Severe constipation, kidney disease, liver disease, and specific muscle disease (myasthenia gravis).
Abnormal heart rhythm: This drug may cause or increase the risk of a specific type of abnormal heart rhythm called QT prolongation. Other medications can also increase the risk of QT interval prolongation when taken together with Tolterodine.
This abnormal heart rhythm is more likely to occur in women, older adults, and people with certain risk factors, such as:
- Heart disease.
- Other heart rhythm problems (such as atrial fibrillation).
- A history of stroke.
- Family history of sudden cardiac death.
- Electrolyte disturbances of the blood.
- Abnormally slow heartbeat
- Eating disorders.
- Diabetes.
- Nervous disorders
If you experience symptoms of an abnormal heart rhythm, such as dizziness, palpitations (fast, pounding, or irregular heartbeats), fainting, or seizures, stop taking this medicine and get medical attention right away.
This medicine can make you sweat less, which increases your chance of heatstroke.
Avoid doing things that can overheat you, such as working hard, exercising in hot weather, or using hot tubs. When it’s hot, drink plenty of fluids and dress lightly.
Bladder problems: People with conditions that significantly block or obstruct the bladder should be closely monitored by their doctor for urine retention when taking this drug.
Driving / using machinery: Tolterodine can cause fatigue or blurred vision. Avoid activities that require mental attention, such as driving, operating machinery, doing dangerous work, or doing anything that requires alertness or clear vision until you can do it safely.
Limit alcoholic beverages, alcohol, and other medications that cause drowsiness can increase the drowsiness caused by Tolterodine.
Glaucoma: People who have controlled narrow-angle glaucoma should discuss the benefits and risks of this medication with their doctor. Tolterodine can make this condition worse.
Kidney or liver disease: People with liver or kidney disease may be at higher risk of experiencing side effects and may require lower doses of this drug.
Pregnancy: This drug should not be used during pregnancy. If you are or may be pregnant, talk to your doctor. Women who can become pregnant should use adequate contraception (birth control) while taking this medicine.
During pregnancy, this medicine should only be used when needed. Discuss the risks and benefits with your doctor.
There are no data available on use in pregnant women to inform the risks associated with the medications.
In animal reproduction studies, oral administration of Tolterodine and its metabolite 5-HMT to pregnant mice during organogenesis did not produce adverse developmental outcomes at doses approximately 9 to 12 times the clinical exposure at a dose of 20 mg/kg/day.
However, higher doses produced adverse developmental outcomes.
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: it can be acceptable. Either animal studies do not show any risk, but human studies are not available, animal studies showed minor risks, and human studies performed and did not show any chance.
C: Use with caution if the benefits outweigh the risks. Animal studies show risks, human studies are not available, or no animal or human studies have been performed.
D: Use in life-threatening emergencies when a safer drug is not available. Positive evidence of human fetal risk.
X: do not use in pregnancy. The risks involved outweigh the potential benefits. There are safer alternatives.
Breastfeeding: It is not known whether Tolterodine passes into breast milk. If you are a breastfeeding mother taking this medicine, it may affect your baby. Talk to your doctor about whether you should continue to breastfeed.
There is no information on the presence in human milk, the effects on the breastfed infant, or milk production; based on limited data; Tolterodine is excreted in milk in mice in low amounts.
The development and health benefits of breastfeeding should be considered in conjunction with the mother’s clinical need for therapy and any possible adverse effects from medication or an underlying maternal condition on the breastfed infant.
Children: The safety and efficacy of using this medicine for children have not been established.
What other drugs can interact with this medicine?
Drug interactions can change how your drugs work or increase your risk of severe side effects. There may be an interaction between Tolterodine and any of the following:
- Alcohol.
- “Azole” antifungals (eg ketoconazole, fluconazole, voriconazole).
- Disopyramide.
- Macrolide antibiotics (e.g., erythromycin, clarithromycin, telithromycin).
- Methadone.
- Quinine.
Other products that may interact with this medication include anticholinergic medications (such as atropine and scopolamine), other antispasmodic medications (such as dicyclomine and propantheline), certain anti-Parkinson’s medications (such as benztropine, trihexyphenidyl), belladonna alkaloids, potassium tablets/capsules of pramlintide.
In addition to Tolterodine, many drugs can affect the heart rhythm (prolonging the QT interval), including amiodarone, dofetilide, pimozide, procainamide, and quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others.
