Action

Competitively antagonizes muscarinic receptors, inhibiting bladder contractions and reducing urinary frequency

Availability

Capsules (extended-release): 2 mg, 4 mg

Tablets: 1 mg, 2 mg

Indications and dosages

➣ Overactive bladder

Adults: 2 mg (immediate-release) P.O. b.i.d.; may decrease to 1 mg P.O. b.i.d. depending on response and tolerance. Or 4 mg (extended-release) P.O. daily; may decrease to 2 mg P.O. daily, depending on response.

Dosage adjustment

• Hepatic impairment or disease

• Renal impairment

• Concurrent use of potent CYP3A4 inhibitors

Contraindications

• Hypersensitivity to drug, its components, or to fesoterodine fumarate extended-release tablets

• Urinary or gastric retention

• Uncontrolled angle-closure glaucoma

Precautions

Use cautiously in:

• GI obstruction, significant bladder outflow obstruction, controlled angle-closure glaucoma, significant hepatic impairment, renal impairment

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Give with food to increase bioavailability.

Adverse reactions

CNS: headache, dizziness, vertigo, drowsiness, paresthesia, fatigue

CV: chest pain

EENT: vision abnormalities, xerophthalmia, pharyngitis

GI: diarrhea, constipation, abdominal pain, dyspepsia, dry mouth

GU: dysuria, urinary retention or frequency, urinary tract infection

Musculoskeletal: joint pain

Skin: dry skin

Other: weight gain, flulike symptoms, infection, anaphylaxis, angioedema

Interactions

Drug-drug. Clarithromycin, erythromycin, itraconazole, ketoconazole, miconazole: inhibited metabolism and increased effects of tolterodine

Drug-food. Any food: increased drug bioavailability

Patient monitoring

Monitor patient for anaphylaxis and angioedema with first or subsequent doses. If difficulty breathing, upper airway obstruction, or fall in blood pressure occurs, discontinue drug and promptly provide appropriate treatment.

Monitor patient for signs and symptoms of anticholinergic CNS effects, particularly after beginning treatment or increasing dosage. Consider dosage reduction or drug discontinuation if symptoms occur.

• Monitor bladder function.

• Assess blood pressure and stay alert for chest pain.

• Monitor neurologic status. Report paresthesia or visual impairment.

Patient teaching

• Tell patient to take with food.

• If patient takes extended-release form, instruct him not to chew or crush it.

Instruct patient how to recognize and immediately report signs and symptoms of anaphylaxis or angioedema.

• Caution patient not to drive or operate heavy machinery until drug's effects are known.

• Advise patient to use sugarless gum or hard candy to relieve dry mouth.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.