tolterodine tartrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
tolterodine tartrate: clinical details
Prescribing considerations
- Exclude or address organic causes of urinary urgency and frequency before treatment.
- Review renal and hepatic function, anticholinergic burden, cognition, bowel function, bladder-emptying risk and QT-risk factors.
- Reassess symptom benefit, tolerability and continuing need periodically.
- Consider older people's susceptibility to confusion and other anticholinergic effects. Current MHRA evidence does not confirm causation of dementia, but a small increased risk cannot be excluded.
Contraindications and cautions
- Urinary retention
- Uncontrolled narrow-angle glaucoma
- Myasthenia gravis
- Severe ulcerative colitis
- Toxic megacolon
- Hypersensitivity to tolterodine or product excipients
Monitoring
- Urgency, frequency and urge-incontinence response
- Dry mouth, constipation, blurred vision, cognitive change and somnolence
- Voiding difficulty or urinary retention in susceptible patients
- Palpitations, syncope or other cardiac symptoms where QT risk is present
- Continuing clinical need and cumulative anticholinergic burden
Clinical pharmacology
Tolterodine is a competitive muscarinic-receptor antagonist. Hepatic CYP2D6 metabolism forms an active, equipotent hydroxymethyl metabolite; CYP3A4 becomes more important in CYP2D6 poor metabolisers.
Formulation and product differences
- Film-coated tablets are immediate-release and should be swallowed whole with fluid.
- Prolonged-release capsules provide slower absorption and must be swallowed whole rather than chewed.
- The selected prolonged-release capsule contains sucrose and may be unsuitable in specified rare hereditary disorders of sugar metabolism.
tolterodine tartrate preparations and strengths
Modified-release capsule
Route: Oral
Strengths: 2 mg, 4 mg
Tablet
Route: Oral
Strengths: 1 mg, 2 mg
tolterodine tartrate interactions
A medication review should consider metabolic interactions, combined anticholinergic effects and cardiac risk.
Clarithromycin, erythromycin, itraconazole, ketoconazole and HIV protease inhibitors
Potent CYP3A4 inhibition can increase tolterodine exposure and toxicity risk; product information does not recommend concomitant systemic use.
Other antimuscarinic or anticholinergic medicines
Combined effects can worsen dry mouth, constipation, blurred vision, confusion and urinary retention.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.