TolterodineTolterodine Tartrate

About Tolterodine

Tolterodine blocks the muscarinic receptors that make the bladder muscle contract, so the bladder holds more and the urge to go comes less often. Its label covers overactive bladder with urge incontinence, urgency and frequency. The tablet is taken twice a day, usually 2 mg, and the extended-release capsule once a day, usually 4 mg, swallowed whole with water, with or without food. The two forms are separate prescriptions.

Dry mouth is the most frequent side effect, followed by headache, constipation and stomach pain; dizziness, sleepiness and blurred vision can affect driving. There is no boxed warning. The label rules it out in urinary retention, gastric retention (a stomach that empties very slowly) and uncontrolled narrow-angle glaucoma, and in anyone allergic to tolterodine or fesoterodine. It is used with caution in bladder outlet obstruction, including an enlarged prostate, in bowel disorders that slow the gut, in treated narrow-angle glaucoma, in myasthenia gravis and with a long QT interval. Swelling of the face, lips, tongue or throat needs emergency care.

The dose is capped when something slows its clearance. With a potent CYP3A4 inhibitor such as ketoconazole, itraconazole, clarithromycin or ritonavir, the label limits the tablet to 1 mg twice a day and the capsule to 2 mg once a day. The same lower doses apply with significantly reduced liver or kidney function, and the capsule is not recommended in severe liver impairment or when kidney function is very poor.

Taking Tolterodine

How to take it

Tablets twice a day, capsules once a day, with or without food. Swallow the capsule whole; do not split, chew or crush it. Do not drive until you know how it affects you.

If you miss a dose

Tablets: the label says to take the next regular dose at the usual time and not to make up the missed one. Capsules: start again the next day, and never take two doses in the same day.

Storage

At room temperature in the original container, tightly closed, away from light, heat and moisture, and out of reach of children.

Interactions to know about

Ketoconazole, itraconazole, miconazole, clarithromycin, ritonavir and other potent CYP3A4 inhibitors raise its levels, so the dose is halved. Other anticholinergic medicines add to dry mouth, constipation and blurred vision, and medicines that prolong the QT interval need care. No meaningful interaction was found with warfarin.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Tolterodine differs from pharmacy to pharmacy

Generic tolterodine tablets have many makers and cost pharmacies little, so a quote is mostly dispensing fee and markup. The extended-release capsules also have many generic makers, but a once-daily capsule costs pharmacies more than a plain tablet, and because a prescription names one form, the price follows the form. A prescription for Detrol by brand, with substitution blocked, is quoted at a brand price.

A pharmacy that seldom fills the capsule may order it in and price it accordingly; one that keeps it on a flat-price list can quote far less for the same strength.

Ways to pay less for Tolterodine without insurance

• Ask the prescriber whether the twice-daily tablet would suit you if the capsule is quoted high.
• Make sure the prescription allows generic substitution, since the brand tablet is still sold.
• Once the dose is settled, ask for a ninety-day supply; it is not a controlled substance.
• If it stays unaffordable, ask the prescriber whether generic oxybutynin or another bladder medicine would do.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Tolterodine

1. 1.Is this the tablet or the extended-release capsule, and how often do I take it?
2. 2.Do any of my medicines, such as an antifungal, antibiotic or HIV drug, mean I need the lower dose?
3. 3.Is it safe with my glaucoma, prostate, constipation or heart rhythm problem?
4. 4.What can I do about dry mouth and constipation?
5. 5.What should I do if I miss a dose?

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