Anticholinergics tolterodine

Overactive bladder Anticholinergic agentyantispas-modics Oxybulynin TDS (5.9 mg/day apply one patch twice weekly), tolterodine IR (1-2 mg twice daily), tolterodine LA (2-4 mg daily), trospium chloride (20 mg once or twice daily), solifenacin (5-10 mg daily), darifenacin (7.5-15 mg daily) Anticholinergics are first-line drug therapy (oxybulynin or tolterodine is preferred). 

Trospium chloride, a quaternary ammonium anticholinergic, is superior to placebo and is equivalent to oxybutynin IR and tolterodine IR. However, clinical studies are limited by their focus on cystometric rather than clinical endpoints, small absolute benefits compared with placebo, and lack of comparisons with LR formulations. 

Substrates CYP3A Anticholinergics Darifenacin, oxybutynin, solifenacin, tolterodine Benzodiazepines Alprazolam, midazolam, triazolam Ca channel blockers Diltiazem, felodipine, nimodip-ine, nifedipine, nisoldipine, verapamil... 

The adverse effects of tolterodine and other antimuscarinic anticholinergic drugs have been reviewed in patients with incontinence and bladder overactivity (3-6). 

Which anticholinergic agent should be used as first-line pharmacotherapy of UUI (oxybutynin, tolterodine, trospium chloride, solifenacin, or dorifenacin) and which formulation of oxybutynin (oral IR, oral XL, or topical) or tolterodine (oral IR, oral LA) is unclear. Financial considerations currently favor generic oxybutynin IR, and this is the initial choice of many clinicians. 

Tolterodine tartrate is an anticholinergic agent that antagonizes the mnscarinic receptor, which mediates nrinary bladder contraction and salivation. It is in indicated in the treatment of overactive bladder with symptoms of nrinary freqnency, urgency, or urge incontinence. 

The aforemehtiohed side effect of causing difficulty in urination has been used to advantage with the recent approval of several anticholinergic agents—darifenacin trospium, solifenacin, tolterodine, and oxybutynin—tor the treatment of overactive bladder. 

The elderly male client is prescribed tolterodine (Detrol-LA), an anticholinergic, for urge incontinence. Which statement would warrant notifying the health-care provider ... 

In praetical terms this means that the antimuscarinic (anticholinergic) effects of the tolterodine are only moderately increased, and it seems unlikely that any tolterodine dosage changes are likely to be needed. Consider also Antimuscarinics + Antimuscarinics , p.674. 

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