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INTRODUCTION

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tolterodine (tol-ter-oh-deen)

Detrol, Detrol LA

Classification

Therapeutic: urinary tract antispasmodics

Pharmacologic: anticholinergics

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Indications
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Treatment of overactive bladder function that results in urinary frequency, urgency, or urge incontinence.

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Action
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Acts as a competitive muscarinic receptor antagonist resulting in inhibition of cholinergically mediated bladder contraction. Therapeutic Effects: ↓ urinary frequency, urgency, and urge incontinence.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness. EENT: blurred vision, dry eyes. GI: dry mouth, constipation, dyspepsia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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.

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Interventions
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  • When appropriate, implement pelvic floor muscle strengthening activities and other therapeutic exercises to help maintain bladder control.

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Patient/Client-Related Instruction
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  • 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).

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Pharmacokinetics
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Absorption: Well absorbed (77%) following oral administration.

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Distribution: Unknown.

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Protein Binding: 96.3%.

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Metabolism and Excretion: Extensively metabolized by the liver; 1 metabolite (5-hydroxymethyltolterodine) is active; other metabolites are excreted in urine.

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Half-life: Tolterodine—1.9–3.7 hr;

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5-hydroxymethyltolterodine—2.9–3.1 hr.

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TIME/ACTION PROFILE (effects on bladder function)

ROUTE ONSET PEAK DURATION
PO unknown unknown 12 hr

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Contraindications/Precautions
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Contraindicated in: Urinary retention; Gastric retention; Uncontrolled angle-closure glaucoma; Lactation.

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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).

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Interactions
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Drug-Drug: Erythromycin, clarithromycin, ketoconazole, itraconazole, and miconazole may inhibit metabolism and ↑ effects of tolterodine.

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Route/Dosage
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PO (Adults): 2 mg bid as tablets; may be lowered depending on response or 2–4 mg once daily as extended-release capsules.

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PO (Adults with Impaired Hepatic Function or Concurrent Enzyme Inhibitors): 1 mg bid.

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Availability
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