Tolterodine is an antimuscarinic agent used in the treatment of enuresis and an overactive bladder .
Bladder disorders are common in people with multiple sclerosis and generally consist of urgency, frequency, incomplete emptying of the bladder, and sometimes incontinence.
A urinary tract infection can explain some of these bladder problems, and it should always be ruled out before starting any medication for ongoing bladder problems in multiple sclerosis.
Detrusitol tablets and extended-release capsules contain the active ingredient tolterodine, which is a type of medicine called an antimuscarinic (or anticholinergic) muscle relaxant.
For what do you use it?
It is used to treat the symptoms of an overactive bladder, such as an increased need to urinate (urinary frequency), uncontrollable urges to urinate (urinary urgency), and involuntary loss of urine ( urinary incontinence ).
Detrusitol is a prescription drug approved by the Food and Drug Administration for the treatment of overactive bladder (leaking, urgency, and going too often). It is often prescribed to multiple sclerosis patients struggling with bladder problems.
Antimuscarinic medications reduce the involuntary contractions of the bladder muscles and increase the capacity of the bladder. Tolterodine works by relaxing the muscles of the bladder and preventing contractions.
How does Detrusitol work?
It works by relaxing the involuntary muscle found in the bladder wall. Tolterodine is also available without a brand name, that is, as a generic drug.
The muscle in the wall of the bladder is called the detrusor muscle. Sometimes it can contract into uncontrollable spasms and this is often referred to as having an overactive bladder.
The overactive detrusor muscle can increase the number of times you need to urinate, or cause uncontrollable urges to urinate or involuntary urine leakage (urinary incontinence).
Tolterodine works by relaxing the detrusor muscle in the bladder wall. It does this by blocking receptors called muscarinic (or cholinergic) receptors that are found on the surface of muscle cells.
This prevents a natural chemical in the body called acetylcholine from acting on these receptors. Normally, when acetylcholine acts on these receptors, it causes the detrusor muscle to contract and the bladder to empty.
By blocking acetylcholine, tolterodine helps relax the muscle in the bladder wall. This reduces unstable and involuntary bladder contractions and thus increases the bladder’s ability to hold urine. In turn, this reduces the urge to urinate.
Detrusitol tablets are known as an immediate release dosage form. This means that the medicine is absorbed into the bloodstream from the intestine shortly after the tablets are taken. These tablets are taken twice a day.
Detrusitol capsules are extended-release capsules. They are designed to release the medicine slowly throughout the day as the capsule passes through the intestine. These capsules should only be taken once a day.
The capsules should be swallowed whole and should not be chewed or crushed, as this would prevent their extended-release action from stopping working.
How to take Detrusitol?
Detrusitol tablets are generally taken twice a day, in the morning and in the evening. However, follow your doctor’s instructions on how many tablets to take and how often to take them.
Try to take your tablets at the same time each day; this will help you remember them. The tablets should be swallowed with a drink.
Detrusitol capsules are taken once a day. Try to take your capsule at the same time each day. Detrusitol capsules should be swallowed whole with a drink and not opened, crushed, or chewed.
If you forget to take a dose, take it as soon as you remember, unless it is almost time for your next dose. In this case, just skip the missed dose and take your next dose as usual when needed. Do not take a double dose to make up for a forgotten dose.
It may take a few weeks of taking this medicine before you see an improvement in your symptoms. It is important to continue taking the medication regularly, even if the benefit is not apparent at first.
Your doctor may want to see you after two to three months to check that the medicine is working for you. Your doctor should re-evaluate you regularly to see if you still need to continue taking this drug.
Warnings with Detrusitol
This medicine can make you sleepy or cause blurred vision, so it may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it will not affect your performance.
Tolterodine is not licensed for use in children, and for this reason the information leaflets included with the medicine will state that the medicine is not recommended for children.
However, specialists sometimes prescribe tolterodine license to treat certain urinary problems in children. If your child has been prescribed this medicine and you want more information, ask your doctor or pharmacist.
Do not use Detrusitol in:
- People who cannot completely empty their bladder (urinary retention).
- Angle closure glaucoma.
- A condition called myasthenia gravis in which there is abnormal muscle weakness.
- People with severe inflammation of the intestinal passage and back (ulcerative colitis).
- People with a sudden expansion of the large intestine, seen in advanced ulcerative colitis or Crohn’s disease (toxic megacolon).
- This medicine should not be used if you are allergic to one of its ingredients.
Use Detrusitol with caution in:
- Elderly people.
- People with decreased kidney function.
- People with decreased liver function.
- People with any obstruction in the outflow of urine from the bladder, causing problems with urination.
- People with some blockage or decreased activity in the stomach or intestines; Symptoms can include constipation.
- People with hiatal hernia.
- Heart disease, for example angina, heart failure, irregular heartbeat (arrhythmias), or very slow heart rate (bradycardia).
- People with a personal or family history of a type of abnormal heart rhythm, seen on a heart monitoring trace (electrocardiogram) as a ‘long QT interval’.
- People taking medicines that increase the risk of a long QT interval (your doctor will know, but see the end of the fact sheet for some examples).
- People with disturbances in the normal levels of salts (electrolytes) in the blood, for example, low levels of magnesium, potassium or calcium.
Pregnancy and breastfeeding
Certain medications should not be used during pregnancy or breastfeeding. However, other medications can be used safely during pregnancy or breastfeeding, as the benefits to the mother outweigh the risks to the fetus.
There is no information available on the safety of this medicine during pregnancy. It is not recommended for use during pregnancy. Seek more medical advice from your doctor.
It is not known if this drug passes into breast milk. For this reason, it is not recommended for use by breastfeeding mothers. Seek more medical advice from your doctor.
Detrusitol side effects
The most common side effects are dry mouth, constipation, headache, and stomach pain. Detrusitol can cause severe allergic reactions, allergic reactions such as swelling of the face, throat and tongue (angioedema).
Just because a side effect is established here does not mean that all people using this drug will experience that or any side effect.
Some of these side effects may occur less frequently with Detrusitol capsules than with Detrusitol tablets.
Medications and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this drug.
Very common (affects more than 1 in 10 people)
- Dry mouth.
Common (affects 1 in 10 to 1 in 100 people)
- Dry eyes.
- Blurry vision.
- Constipation .
- Abdominal pain.
- Excess gas in the stomach and intestines (flatulence or wind).
- Difficulty urinating.
- Dizziness or a feeling of being tipped over
- Pins and needles sensations (paresthesia).
- Dry Skin.
- Swelling of the legs and ankles due to excessive fluid retention (peripheral edema).
- Awareness of your heartbeat (palpitations).
- Chest pain.
Uncommon (affects between 1 in 100 and 1 in 1000 people)
- Irregular heartbeats (arrhythmias).
- Increased heart rate (tachycardia).
- Heart failure
- Memory problems.
- Feeling disoriented
The side effects listed above may not include all the side effects reported by the drug manufacturer.
For more information on other possible risks associated with this medicine, read the information provided with the medicine or consult your doctor or pharmacist.
How can Detrusitol affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before starting treatment with this medicine.
Similarly, consult your doctor or pharmacist before taking any new medications while taking this one, so they can verify that the combination is safe.
The following medications are not recommended for use in combination with tolterodine, as they can increase the blood level of tolterodine and increase the risk of its side effects:
- Macrolide antibiotics such as clarithromycin and erythromycin. The antifungals ketoconazole and itraconazole.
- Protease inhibitors for HIV infection, eg amprenavir, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir.
There may be an increased risk of side effects such as dry mouth, blurred vision, constipation, and difficulty urinating if this drug is taken with other drugs that have antimuscarinic effects, for example the following:
- Amantadine Antimuscarinic drugs for Parkinson’s symptoms, eg procyclidine, orphenadrine, trihexyphenidyl. Antipsychotic drugs, eg haloperidol, chlorpromazine, clozapine.
- Antispasmodic drugs, eg hyoscine, atropine, propantheline. Codeine. Disopyramide Monoamine oxidase inhibitor (MAOI) antidepressants, eg phenelzine, tranylcypromine.
- Nefopam. Sedative antihistamines, eg brompheniramine, chlorphenamine, promethazine. Tricyclic antidepressants, eg amitriptyline, clomipramine.
If you experience dry mouth as a side effect of this medication, it is possible that medications designed to dissolve and be absorbed from the lower part of the tongue, for example, sublingual glyceryl trinitrate (GTN) tablets , are less effective.
This is because the tablets do not dissolve properly in dry mouth. To resolve this, have a drink of water before taking sublingual tablets. This medicine can reduce the effects of the following medicines in the intestine:
There may be an increased risk of abnormal heart rhythms (as a result of a prolonged QT interval on the heart monitoring trace or EKG) if this drug is used in combination with other drugs that are associated with this possible side effect, such as the following:
- Arsenic trioxide, certain antimalarials, eg halofantrine, chloroquine, quinine, Riamet, certain antimicrobials, eg erythromycin (IV), clarithromycin, moxifloxacin, voriconazole, or pentamidine.
- Certain antipsychotics, eg thioridazine, chlorpromazine, sertindole, haloperidol, pimozide, droperidol, cisapride.
- Medicines to treat abnormal heart rhythms, eg amiodarone, procainamide, quinidine, disopyramide, dronedarone, sotalol, ranolazine, saquinavir, sildenafil.
The antihistamines astemizole, terfenadine, or mizolastine. vardenafil. Other medicines that contain the same active ingredient.
- Blerone XL.
- Inconex XL.
- Neditol XL.
- Preblacon XL.
- Santizor XL.
Tolterodine tablets are also available without a brand name, that is, as a generic drug.