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Thursday, February 10, 2011

tolterodine tartrate

Posted by Sampil 2:25 AM, under | No comments

tolterodine tartrate
(toll tear' oh dyne)
DetrolDetrol LA

Pregnancy Category C

Drug class
Antimuscarinic

Therapeutic actions
Competitively blocks muscarinic receptor sites; bladder contraction is mediated by muscarinic receptors—blocking these receptors decreases bladder contraction.

Indications
·        Treatment of overactive bladder in patients with symptoms of urinary frequency, urgency, or incontinence

Contraindications and cautions
·        Contraindicated with urinary retention, uncontrolled narrow-angle glaucoma, gastric retention, allergy to the drug or any of its components.
·        Use cautiously with renal or hepatic impairment, pregnancy, lactation.

Available forms
Tablets—1, 2 mg; ER capsules—2, 4 mg

Dosages
ADULTS
2 mg PO bid, may be lowered to 1 mg PO bid based on individual response; ER capsules—4 mg PO taken once a day; may be lowered to 2 mg qd based on response.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC AND RENAL IMPAIRMENT
Reduce dosage to 1 mg PO bid (2 mg daily ER capsules) and monitor patient.

Pharmacokinetics
Route
Onset
Duration
Oral
1–2 hr
6–8 hr

Metabolism: Hepatic; T1/2: 1.9–3.7 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
·        CNS: Blurred vision, headache, dizziness, somnolence
·        Dermatologic: Pruritus, rash, erythema, dry skin
·        GI: Nausea, vomiting, constipation, dyspepsia, flatulence, dry mouth, abdominal pain
·        GU: Dysuria, urinary retention; impotence, UTIs
·        Other: Weight gain, pain, fatigue, acute myopia and secondary angle closure glaucoma (pain, visual changes, redness, increased IOP)

Interactions
·        Risk of increased serum levels and toxicity if given with drugs that inhibit CYP450 2D6 (such as fluoxetine); reduce dose to 1 mg PO bid (2 mg daily ER capsules)

Nursing considerations
Assessment
·        History: Presence of urinary retention; uncontrolled narrow-angle glaucoma; allergy to the drug or any of its components; renal or hepatic impairment; pregnancy, lactation
·        Physical: Bowel sounds, normal output; normal urinary output, prostate palpation; IOP, vision; LFTs; renal function tests; skin color, lesions, texture; weight

Interventions
·        Provide small, frequent meals if GI upset is severe.
·        Provide frequent mouth hygiene or skin care if dry mouth or skin occur.
·        Arrange for safety precautions if blurred vision occurs.
·        Monitor bowel function and arrange for bowel program if constipation occurs.

Teaching points
·        Take drug exactly as prescribed.
·        You may experience these side effects: Constipation (ensure adequate fluid intake, proper diet, consult your health care provider if this becomes a problem); dry mouth (suck sugarless lozenges, practice frequent mouth care; this effect sometimes lessens over time); blurred vision (it may help to know that these are drug effects that will go away when you discontinue the drug; avoid tasks that require acute vision); difficulty in urination (it may help to empty the bladder immediately before taking each dose of drug).
·        Report rash, flushing, eye pain, difficulty breathing, tremors, loss of coordination, irregular heartbeat, palpitations, headache, abdominal distention.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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