Detrol: Effective Overactive Bladder Symptom Control
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Synonyms | |||
Detrol (tolterodine tartrate) is a prescription medication specifically formulated for the management of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and frequency. As an antimuscarinic agent, it works by relaxing the bladder muscle, thereby increasing storage capacity and reducing the symptoms associated with involuntary bladder contractions. This medication is a cornerstone in urological therapeutic strategies, offering a balance of efficacy and tolerability for appropriate patient populations.
Features
- Active ingredient: Tolterodine tartrate
- Available in immediate-release (IR) tablets (1 mg and 2 mg) and extended-release (ER) capsules (2 mg and 4 mg)
- Selective muscarinic receptor antagonist with specificity for bladder tissue
- Demonstrated efficacy in multiple randomized, double-blind, placebo-controlled clinical trials
- Suitable for long-term management of overactive bladder symptoms
Benefits
- Significantly reduces episodes of urge urinary incontinence
- Decreases urinary urgency and frequency, allowing for improved daily planning and uninterrupted sleep
- Enhances quality of life by restoring confidence and reducing anxiety related to bladder control
- Provides flexible dosing options (IR and ER formulations) to accommodate individual patient needs and lifestyles
- Exhibits a favorable side effect profile when used as directed in appropriate patient populations
Common use
Detrol is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. It is prescribed for adults who experience these disruptive symptoms, which often interfere with social, occupational, and recreational activities. The medication is typically considered after behavioral modifications (e.g., bladder training, fluid management) have been insufficient. It is not indicated for the treatment of stress urinary incontinence or other non-OAB voiding dysfunctions.
Dosage and direction
The recommended initial dose for Detrol immediate-release tablets is 2 mg twice daily. The dose may be lowered to 1 mg twice daily based on individual response and tolerability. For Detrol LA extended-release capsules, the recommended dose is 4 mg once daily. For patients with significantly impaired liver function or who are taking potent CYP3A4 inhibitors, the dose should be reduced to 1 mg twice daily (IR) or 2 mg once daily (ER). Tablets should be swallowed whole with water and may be taken with or without food. Dosage adjustments should only be made under the supervision of a healthcare provider.
Precautions
Patients should be advised that Detrol may cause blurred vision or drowsiness; activities requiring mental alertness such as driving or operating machinery should be undertaken with caution until the patient’s response is known. Use with caution in patients with clinically significant bladder outflow obstruction, gastrointestinal obstructive disorders, renal impairment, or hepatic impairment. Monitor for signs of urinary retention in patients with bladder outflow obstruction. Patients with congenital or acquired QT prolongation should use Detrol with caution. Heat prostration may occur in patients exposed to high environmental temperatures due to decreased sweating.
Contraindications
Detrol is contraindicated in patients with urinary retention, gastric retention, or uncontrolled narrow-angle glaucoma. It is also contraindicated in patients with known hypersensitivity to tolterodine tartrate or any component of the formulation. Should not be used in patients with myasthenia gravis or severe ulcerative colitis. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) is contraindicated in patients with impaired CYP3A4 metabolism.
Possible side effect
Common adverse reactions (≥4%) include: dry mouth (35%), headache (11%), constipation (7%), abdominal pain (7%), dyspepsia (6%), xerophthalmia (dry eyes, 5%), somnolence (4%), and dizziness (4%). Less frequent side effects may include: urinary retention, confusion (particularly in elderly patients), tachycardia, blurred vision, nausea, and fatigue. Serious but rare adverse effects include: angioedema, QT prolongation, and anaphylactic reactions. Patients should report any persistent or severe side effects to their healthcare provider.
Drug interaction
Detrol is primarily metabolized by CYP2D6 and CYP3A4 enzymes. Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin) may significantly increase tolterodine concentrations. Drugs that prolong the QT interval (e.g., class IA and III antiarrhythmics) may have additive effects. Anticholinergic drugs may enhance the therapeutic and adverse effects of Detrol. Use with other centrally-acting drugs may enhance cognitive effects. Fluoxetine (a CYP2D6 inhibitor) may increase tolterodine concentrations in extensive metabolizers.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Patients should be advised to maintain a consistent dosing schedule to ensure optimal therapeutic effect.
Overdose
In case of overdose, symptoms may include severe central anticholinergic effects (e.g., blurred vision, dry mouth, difficulty urinating), cardiovascular effects (e.g., tachycardia, QT prolongation), and CNS effects (e.g., confusion, hallucinations, seizures). Treatment should be symptomatic and supportive. ECG monitoring is recommended in cases of significant overdose. Activated charcoal may be administered if presented soon after ingestion. Dialysis is unlikely to be beneficial due to tolterodine’s high protein binding and extensive metabolism.
Storage
Store at room temperature (20-25°C or 68-77°F); excursions permitted to 15-30°C (59-86°F). Keep in the original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication after treatment completion.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Detrol is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual results may vary. Patients should not initiate, discontinue, or change dosage without consulting their physician. The full prescribing information should be consulted before use.
Reviews
Clinical studies demonstrate that Detrol significantly reduces weekly urge incontinence episodes (mean reduction of 15-20 episodes vs 8-10 for placebo) and micturition frequency. In long-term extension studies, efficacy was maintained for up to 12 months of treatment. Patient-reported outcomes show significant improvements in quality of life measures. The extended-release formulation offers the advantage of once-daily dosing with maintained efficacy and potentially improved tolerability regarding dry mouth. Real-world evidence supports its position as a first-line pharmacological option for overactive bladder management when behavioral therapies are insufficient.