tolterodine tartrate

tolterodine tartrate

(toll tear' oh dyne)

Detrol, Detrol 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; T_1/2: 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

Drug-drug

·        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.