Tolterodine
DETROL
Pronunciation: toel-TER-a-deen (DEE-trol)
“Total rodent Detrusor control”
treatment for overactive bladder (OAB)
“red as a beet” → anticholinergic
What it isMuscarinic antagonist; overactive bladder.
Why this oneIts extended-release capsule causes less dry mouth than the immediate-release tablet, making formulation choice its practical edge.
What limits itAnticholinergic burden persists, so caution in the elderly. CYP2D6 substrate with CYP3A4 backup; QT prolongation.
FDA-approved for
- overactive bladder (1998)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Overactive bladder (urge incontinence, urgency, frequency) | Adults | 2 mg BID | 2 mg BID (may lower to 1 mg BID) | 2 mg BID |
Renal Significantly reduced renal function: 1 mg BID.
Hepatic Significantly reduced hepatic function: 1 mg BID.
Instructions
- Reduce to 1 mg BID with potent CYP3A4 inhibitors
Available strengths
- tab 1, 2 mg
- ER cap 2, 4 mg
Contraindications
- Urinary retention
- Gastric retention
- Uncontrolled narrow-angle glaucoma
Cautions
- Angioedema/anaphylaxis
- Anticholinergic CNS effects (dizziness, somnolence)
- Bladder outflow/GI obstructive disorders
- QT prolongation
- Myasthenia gravis
Adverse reactions
- Dry mouth
- Headache
- Constipation
- Vertigo/dizziness
- Abdominal pain
- Abnormal vision
Pregnancy Pregnancy Category C; use only if potential benefit justifies risk (animal fetal abnormalities at high doses).
Lactation Undefined.
Cost
Generic entry2012
NO BOXED WARNINGS
Principal riskAnticholinergic burden
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
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