Buy Detrol Online

Detrol LA (tolterodine tartrate)

OTHER BRAND NAMES

Detrol

THERAPEUTIC CLASS

Muscarinic antagonist

DEA CLASS

RX

INDICATIONS

Treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.

ADULT DOSAGE

Overactive Bladder

Cap, Extended-Release:
Usual: 4mg qd; may be lowered to 2mg qd based on response and tolerability

Tab:
Usual: 2mg bid; may be lowered to 1mg bid based on response and tolerability

DOSING CONSIDERATIONS

Concomitant Medications
Potent CYP3A4 Inhibitors:
Cap, ER:
Usual: 2mg qd

Tab:
Usual: 1mg bid

Renal Impairment
Cap, ER:
CrCl 10-30mL/min:
Usual: 2mg qd
CrCl <10mL/min: Not recommended

Tab:
Significantly Reduced Renal Function:
Usual: 1mg bid

Hepatic Impairment
Cap, ER:
Mild to Moderate (Child-Pugh Class A or B):
Usual: 2mg qd
Severe (Child-Pugh Class C): Not recommended

Tab:
Significantly Reduced Hepatic Function:
Usual: 1mg bid

ADMINISTRATION

Oral route

Cap, ER
Take w/ water and swallow whole

HOW SUPPLIED

Cap, ER: (Detrol LA) 2mg, 4mg; Tab: (Detrol) 1mg, 2mg

CONTRAINDICATIONS

Urinary/gastric retention, uncontrolled narrow-angle glaucoma, hypersensitivity to fesoterodine fumarate ER tab.

WARNINGS/PRECAUTIONS

Anaphylaxis/angioedema requiring hospitalization and emergency treatment occurred with 1st or subsequent doses; d/c and provide appropriate therapy if difficulty in breathing, upper airway obstruction, or fall in BP occurs. Risk of urinary retention; caution in patients with clinically significant bladder outflow obstruction. Risk of gastric retention; caution in patients with GI obstructive disorders (eg, pyloric stenosis). Caution with decreased GI motility (eg, intestinal atony), myasthenia gravis, known history of QT prolongation, hepatic/renal impairment, and in patients being treated for narrow-angle glaucoma. CNS anticholinergic effects (eg, dizziness, somnolence) reported; may impair physical/mental abilities. Monitor for signs of anticholinergic CNS effects (particularly after beginning treatment and increasing the dose); consider dose reduction or d/c if such effects occur.

ADVERSE REACTIONS

Dry mouth, dizziness, headache, abdominal pain, constipation.

DRUG INTERACTIONS

Caution with Class IA (eg, quinidine, procainamide) or Class III (eg, amiodarone, sotalol) antiarrhythmics. May aggravate dementia symptoms when initiating therapy in patients taking cholinesterase inhibitors. Increased concentrations with ketoconazole or other potent CYP3A4 inhibitors (eg, itraconazole, miconazole, clarithromycin). Increased levels with fluoxetine reported with IR tolterodine. May increase the frequency and/or severity of anticholinergic effects with other anticholinergic (antimuscarinic) agents.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Muscarinic receptor antagonist; competitive antagonist of acetylcholine at postganglionic muscarinic receptors mediating urinary bladder contraction and salivation via cholinergic muscarinic receptors.

PHARMACOKINETICS

Absorption: Administration of variable doses resulted in different parameters in extensive metabolizers (EMs) and poor metabolizers (PMs) of CYP2D6. (Tab) Rapid. Distribution: Plasma protein binding (96.3%); (IV) Vd=113L. Metabolism: Liver (extensive); oxidation to 5-hydroxymethyl tolterodine (active metabolite) via CYP2D6; dealkylation via CYP3A4 (PMs). Elimination: Urine (77%), feces (17%). (Tab) Single Dose: EMs: T1/2=2 hrs; PMs: T1/2=6.5 hrs. (Cap, ER) Single Dose: EMs: T1/2=8.4 hrs.

ASSESSMENT

Assess for hypersensitivity to the drug or fesoterodine fumarate, urinary/gastric retention, bladder outflow obstruction, GI obstructive disorders, decreased GI motility, narrow-angle glaucoma, myasthenia gravis, history of QT prolongation, hepatic/renal impairment, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for anaphylaxis, angioedema, difficulty breathing, upper airway obstruction, fall in BP, urinary retention, gastric retention, CNS anticholinergic effects, QT prolongation, hypersensitivity reactions, and other adverse reactions.

PATIENT COUNSELING

Inform patients that drug may produce blurred vision, dizziness, or drowsiness. Advise to exercise caution against potentially dangerous activities until drug's effects have been determined.

STORAGE

(Tab): 25°C (77°F); excursions permitted to 15-30°C (59-86°F). (Cap, ER): 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Protect from light.

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