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Tolterodine.

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VOL: 102, ISSUE: 23, PAGE NO: 27

Generic and proprietary names

Generic and proprietary names
- Tolterodine.

- Detrusitol.

Action
- Tolterodine is an antimuscarinic drug.

- It reduces involuntary detrusor contractions that cause urgency and urge incontinence.

- Reducing contractions increases bladder capacity and delays the desire to empty the bladder.

Classification
- Obstetrics, gynaecology, and urinary-tract disorders.

- Drugs for urinary frequency, enuresis and incontinence.

Indications
- Urinary frequency.

- Urgency and incontinence.

Contraindications
- Myasthenia gravis.

- Glaucoma.

- Significant bladder outflow obstruction or urinary retention.

- Severe ulcerative colitis.

- Toxic megacolon.

- Gastrointestinal obstruction.

- Intestinal atony.

- Pregnancy or breastfeeding.

Cautions
- Older patients, especially if frail.

- Autonomic neuropathy.

- Hiatus hernia with reflux oesophagitis.

- Hepatic or renal impairment.

- Hyperthyroidism.

- Coronary artery disease.

- Congestive heart failure.

- Hypertension.

- Arrhythmias and tachycardia.

- Prostatic hypertrophy.

Side-effects
- Dyspepsia.

- Fatigue or drowsiness.

- Flatulence.

- Chest pain.

- Dry eyes.

- Peripheral oedema.

- Paraesthesia.

- Dry mouth.

- Gastrointestinal disturbance.

- Blurred vision.

- Difficulty in micturition.

- Palpitation.

- Skin reactions.

- Headache.

- Diarrhoea.

- Angioedema.

- Central nervous system problems.

Interactions
- Increased side-effects from anticholinergic medication if taken with tolterodine.

- Tolterodine may reduce the effects of domperidone and metoclopramide.

- Some antifungal and antibacterial medication may increase blood tolterodine levels.

Administration
- Tablets.

- Modified release capsules.

Nursing considerations

- Children and older people are at higher risk of side-effects.

- Antimuscarinic drugs may reduce sweating, leading to heat sensations and fainting in hot environments or in patients who have fever.

- Incontinence in adults arising from detrusor instability is managed by combining drug therapy with conservative methods for managing urge incontinence, such as pelvic floor exercises and bladder training.

- Stress incontinence is generally managed by non-drug methods.

- Tolterodine can trigger glaucoma. Therefore, periodic eye testing should be performed.

Patient teaching
- The need for continuing therapy should be reviewed after 3-6 months.

- Patients should be warned of the possible side-effects of drowsiness or disorientation and advised not to drive or undertake hazardous work if affected.

- Avoid alcohol with this medication as it increases the sedative side-effects.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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