Urinary incontinence tolterodine

A number of muscarinic agonists and antagonists are launched or in clinical trials, especially as antiemetics (e.g. scopolamine), as treatment for urinary incontinence (e.g. tolterodine), glaucoma (pilocarpine), and airway diseases (e.g. ipratropium bromide), but, to the best of our knowledge, only few are used as adjuvants in analgesic compositions, e.g. tiemonium iodide which is used in various combinations with analgesics like paracetamol or metamizole (Coffalon , Visceralgine ). 

Tolterodine, muscarinic antagonist, launched for the treatment of urinary incontinence (Crandall, 2001 Nilvebrant, 2001)... 

Dmochowski RR, Sand PK, Zinner NR, et al. Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology 2003 62 237-242. 

Detrol Kabi 2234 PNU 200583 Tolterodina Toltero-dine (+)-Tolterodine Tolterodinum. Antimuscarinic. Used to treat urinary incontinence. Pharmacia Upjohn. 

Overactive urinary bkuMer disease can be successfully treated with muscarinic antagonists, primarily tolterodine and trospium chloride, which lower intravesicular pressure, increase capacity, and reduce the frequency of contractions by antagonizing parasympathetic control of the bladder. Oxybu-tynin is used as a transdermal system (oxytrol) that delivers 3.9 mg/day and is associated with a lower incidence of side effects than the oral immediate- or extended-release formulations. Tolterodine is metabolized by CYP2D6 to a 5-hydroxymethyl metabolite since this metabolite possesses similar activity to the parent drug, variations in CYP2D6 levels do not affect the duration of drug action. Trospium is as effective as oxybutynin, with better tolerability. Solifenacin is newly approved for overactive bladder with a favorable efficacy side effect ratio. Stress urinary incontinence has been treated with some success with duloxetine (YENTREVE), which acts centrally to influence 5-HT and NE levels. 

The applicability of the asymmetrie cross-coupling reaction for the enan-tioseleetive construction of pharmaceutically relevant benzhydryl derivatives was exemplified through the eonstruetion of (/ )-tolterodine (Detrol LA), a therapeutie used for the treatment of urinary incontinence (Scheme 13.7). 

Tolterodine, a competitive muscarinic receptor antagonist, is considered first-line therapy in patients with urinary frequency, urgency, or urge incontinence. 

A 46-year-old woman took tolterodine 4 mg/day for stress incontinence (623). Her urinary symptoms were... 

Tolterodine, a competitive muscarinic receptor antagonist, is considered first-line therapy in patients with urinary frequency, urgency, or urge incontinence. Controlled studies demonstrate that tolterodine is more effective than placebo and as effective as oxybutynin IR in decreasing the number of daily micturitions and increasing the volume voided per micturition. However, most studies have not shown a decrease in the number of daily UI episodes as compared with placebo. 

Urinary frequency, urgency and incontinence flavoxate, tolterodine, oxybutynin (antimuscarinics) may be useful they may cause retention of urine if there is anatomical obstruction. The pain (with reflex muscle spasm) of an indwelling catheter may be alleviated by diazepam. 

Propiverine, tolterodine and trospium diminish im-stable detrusor contractions and are used to reduce urinary frequency, urgency and incontinence. 

In a controlled study of 1529 adult outpatients with urinary frequency and UUI, tolterodine LA, an extended-release formulation of tolterodine tartrate, significantly decreased the mean number of weekly incontinence episodes (23% effect rate over placebo and 7% effect rate over tolterodine IR). Patient withdrawal rates did not differ significantly between the two active treatments, but dry mouth was observed significantly less often in patients taking the LA formulation than among those patients receiving the IR formulation. ... 

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