Tolterodine Tartrate (Detrol, Detrol LA) Uses, Dosage, Adverse Effects

Tolterodine Tartrate (tol-ter′o-deen tar′trate)

Detrol, Detrol LA

Classifications: ANTICHOLINERGIC; MUSCARINIC RECEPTOR ANTAGONIST

Therapeutic: ANTIMUSCARINIC; BLADDER ANTISPASMODIC

Prototype: Oxybutynin

Pregnancy Category: C

AVAILABILITY

Tablet; sustained release capsule

ACTION & THERAPEUTIC EFFECT

Selective muscarinic urinary bladder receptor antagonist. Reduces urinary incontinence, urgency, and frequency. Controls urinary bladder incontinence by controlling contractions.

USES

Overactive bladder, urinary incontinence, urinary urgency.

CONTRAINDICATIONS

Hypersensitivity to tolterodine or fesoterodine; uncontrolled narrow-angle glaucoma; gastric retention; urinary retention; lactation. Tolterodine ER: Severe hepatic impairment (Child- Pugh class C).

CAUTIOUS USE

Cardiovascular disease; liver disease; controlled narrow-angle glaucoma; significant urinary retention; severe hepatic impairment; obstructive GI disease; obstructive uropathy; MG; history of QT prolongation; paralytic ileus or intestinal atony; renal impairment; ulcerative colitis; older adults; pregnancy (category C). Efficacy in pediatric population has not been established.

ROUTE & DOSAGE

Overactive Bladder

Adult: PO 2 mg b.i.d. or 4 mg (sustained release) daily

Hepatic Impairment Dosage Adjustment

Reduce dose by 50%

Renal Impairment Dosage Adjustment

CrCl less than 30 mL/min: Reduce dose 50%

ADMINISTRATION

Oral

• Do not crush or chew sustained release tablets. These must be swallowed whole.
• Doses greater than 1 mg b.i.d. are not recommended for those with significantly reduced liver function or kidney function or concurrently receiving macrolide antibiotics, azole antifungal agents, or other cytochrome P450 3A4 inhibitors.
• Store at 20°–25° C (68°–77° F) in a tightly closed container.

ADVERSE EFFECTS (≥1%)

Body as a Whole: Back pain, fatigue, flu-like syndrome, falls, arthralgia, weight gain. CNS: Headache, paresthesias, vertigo, dizziness, nervousness, somnolence. CV: Chest pain, hypertension. GI: Dry mouth, dyspepsia, constipation, abdominal pain, diarrhea, flatulence, nausea, vomiting. Urogenital: Dysuria, micturition frequency, urinary retention, UTI. Respiratory: Bronchitis, cough, pharyngitis, rhinitis, sinusitis, URI. Skin: Pruritus, rash, erythema, dry skin. Special Senses: Dry eyes, vision abnormalities.

INTERACTIONS

Drug: Additive anticholinergic effects with amantadine, amoxapine, bupropion, clozapine, cyclobenzaprine, disopyramide, maprotiline, olanzapine, orphenadrine, SEDATING H1-BLOCKERS, PHENOTHIAZINES, TRICYCLIC ANTIDEPRESSANTS. Increased effects with clarithromycin, cyclosporine, erythromycin, itraconazole, or ketoconazole. Food: Grapefruit juice may increase tolterodine levels in some patients.

PHARMACOKINETICS

Absorption: 77% absorbed, decreased with food. Peak: 1–2 h. Distribution: 96% protein bound. Metabolism: In liver by CYP2D6 active metabolite. Elimination: 77% in urine, 17% in feces. Half-Life: 1.9–3.7 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Monitor voiding pattern and report promptly urinary retention.
• Monitor vital signs carefully (HR and BP), especially in those with cardiovascular disease.

Patient & Family Education

• Notify prescriber promptly if you experience eye pain, rapid heartbeat, difficulty breathing, skin rash or hives, confusion, or incoordination.
• Report blurred vision, sensitivity to light, and dry mouth (all common adverse effects) to prescriber if bothersome.
• Avoid the use of alcohol or OTC antihistamines.

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Ditulis oleh Unknown pada tanggal Monday, November 2, 2015