Antimuscarinic
Pregnancy: C
Fesoterodine
Brand names: Toviaz
Adult dose
Dose: 4 mg once daily, increase to 8 mg after 4 weeks if needed
Route: oral
Frequency: once daily
Max: 8 mg/day
Do not exceed 4 mg/day with CYP3A4 inhibitors; swallow whole; prodrug of 5-hydroxymethyl tolterodine
Paediatric dose
Route:
Not licensed in children
Dose adjustments
Renal
Max 4 mg/day if eGFR <30 ml/min
Hepatic
Avoid in severe hepatic impairment
Clinical pearls
- Dose-titration approach allows optimisation of benefit/tolerability balance
- Active metabolite identical to tolterodine — more predictable pharmacokinetics
- BEERS criteria: caution in older adults
Contraindications
- Urinary retention
- Uncontrolled narrow-angle glaucoma
- Myasthenia gravis
- Severe hepatic impairment
Side effects
- Dry mouth
- Constipation
- Headache
- Blurred vision
- Insomnia
- UTI
Interactions
- Potent CYP3A4 inhibitors (max 4 mg/day)
- Other antimuscarinics
Monitoring
- OAB symptom scores
- Residual urine volume
- Cognitive function in elderly
Reference: BNFc; BNF 86; NICE NG123. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs