Antimuscarinic
Pregnancy: C
Tolterodine
Brand names: Detrusitol
Adult dose
Dose: 2 mg twice daily or 4 mg once daily (MR)
Route: oral
Frequency: twice daily (IR) or once daily (MR)
Max: 4 mg/day
Modified-release 4 mg preferred for compliance; reduce to 1 mg BD in hepatic impairment or with CYP3A4 inhibitors
Paediatric dose
Route:
Not licensed in children
Dose adjustments
Renal
Reduce dose if eGFR <30 ml/min
Hepatic
Reduce dose in hepatic impairment
Clinical pearls
- Better tolerated than oxybutynin — fewer CNS side effects due to limited blood-brain barrier penetration
- BEERS criteria: caution in elderly (cognitive impairment, urinary retention, falls)
- MR formulation improves adherence and reduces peak-related side effects
Contraindications
- Urinary retention
- Uncontrolled narrow-angle glaucoma
- Myasthenia gravis
- Severe ulcerative colitis
Side effects
- Dry mouth
- Constipation
- Blurred vision
- Dry eyes
- Cognitive impairment in elderly
- QT prolongation
Interactions
- CYP3A4 inhibitors (increase levels)
- Other antimuscarinics (additive)
- Drugs prolonging QT
Monitoring
- Urinary symptoms
- 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