Detrol, Detrol LA
Therapeutic: urinary tract antispasmodics
Treatment of overactive bladder function that results in urinary frequency, urgency, or urge incontinence.
Acts as a competitive muscarinic receptor antagonist resulting in inhibition of cholinergically mediated bladder contraction. Therapeutic Effects: ↓ urinary frequency, urgency, and urge incontinence.
Adverse Reactions/Side Effects
CNS: headache, dizziness. EENT: blurred vision, dry eyes. GI: dry mouth, constipation, dyspepsia.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Monitor signs of urine retention (difficult urination, painful or distended abdomen). Excessive urinary retention may require dose adjustment by physician.
Advise patient to increase fluid intake and dietary fiber to avoid constipation. Laxatives may also be helpful in patients susceptible to fecal impaction.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, blurred vision, dry eyes, or GI problems (dry mouth, indigestion).
Absorption: Well absorbed (77%) following oral administration.
Metabolism and Excretion: Extensively metabolized by the liver; 1 metabolite (5-hydroxymethyltolterodine) is active; other metabolites are excreted in urine.
Half-life: Tolterodine—1.9–3.7 hr;
Contraindicated in: Urinary retention; Gastric retention; Uncontrolled angle-closure glaucoma; Lactation.
Use Cautiously in: GI obstructive disorders, including pyloric stenosis (increased risk of gastric retention); Significant bladder outflow obstruction (↑ risk of urinary retention); Controlled angle-closure glaucoma; Significant hepatic impairment (lower doses recommended); Impaired renal function; Pregnancy (safe use not established; use only if potential maternal benefit justifies potential risk to fetus); Children (safety not established).
Drug-Drug: Erythromycin, clarithromycin, ketoconazole, itraconazole, and miconazole may inhibit metabolism and ↑ effects of tolterodine.
PO (Adults): 2 mg bid as tablets; may be lowered depending on response or 2–4 mg once daily as extended-release capsules.
PO (Adults with Impaired Hepatic Function or Concurrent Enzyme Inhibitors): 1 mg bid.