Tolterodine 💊
💊 Tolterodine is used for urge incontinence rather than stress incontinence.
It may be tried as a short course in patients with urge or mixed urge/stress symptoms.
📖 About
Always check the BNF link here for up-to-date prescribing advice.
- Antimuscarinic drug, related to oxybutynin but often better tolerated.
- Acts on bladder smooth muscle to reduce detrusor overactivity.
⚙️ Mechanism of Action
- Competitive muscarinic acetylcholine receptor antagonist.
- Reduces involuntary bladder contractions.
- Increases bladder capacity and delays urgency.
🎯 Indications
- Urinary frequency, urgency, and urge incontinence 🚻.
- Mixed stress/urge incontinence (as part of trial therapy).
- Reduces detrusor instability and improves bladder storage.
🔗 Interactions
- Avoid co-prescribing with other antimuscarinics (e.g. tricyclic antidepressants).
- Ketoconazole and other CYP3A4 inhibitors may ↑ tolterodine concentrations.
⛔ Contraindications / Cautions
- ⚠️ Narrow-angle glaucoma (risk of acute angle closure).
- ⚠️ Myasthenia gravis.
- ⚠️ Congenital or acquired QT prolongation (risk of arrhythmia).
- Caution in elderly patients due to CNS side effects.
⚠️ Side Effects
- Dry mouth, constipation, blurred vision 👁️.
- Urinary retention 💧.
- Tachycardia, palpitations ❤️.
- Confusion, cognitive impairment, drowsiness 🧠 (particularly in elderly).
- Peripheral oedema.
💊 Dose
- Tolterodine 1–2 mg twice daily (lower dose in elderly or frail patients).
- Modified-release preparation available for once-daily use.
📚 References
- BNF – Tolterodine
- NICE NG123 – Urinary incontinence and pelvic organ prolapse in women.
- Oxford Handbook of Urology.
