Olanzapine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering tolterodine with olanzapine. headache. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. However, EEG data show no significant difference with tolterodine vs placebo in psychiatric events reported, even in elderly patients, so continued precautions with driving or other tasks are not expected. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Adagrasib: (Major) Avoid concomitant use of adagrasib and tolterodine due to the potential for increased tolterodine exposure and additive risk for QT/QTc prolongation and torsade de pointes (TdP). Consider alternatives to these other medications, if available. Inotuzumab has been associated with QT interval prolongation. Also, concomitant use of vemurafenib and tolterodine may result in altered concentrations of tolterodine. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. Dolutegravir; Rilpivirine: (Moderate) Caution is advised when administering rilpivirine with tolterodine as concurrent use may increase the risk of QT prolongation. [31112] However, geriatric patients have a greater risk of experiencing anticholinergic adverse effects (e.g., dry mouth, constipation, confusion) compared to younger adults. Tolterodine 4 MG: PRESCRIPTION REQUIRED: Mandatory: PRODUCT FORM: Capsule: ABOUT: Urotol Er 4mg Capsule belongs to the therapeutic classification of Drugs for UTI Infections. Additive anticholinergic effects may also be seen when phenothiazines are used concomitantly with any antimuscarinics. Managing tolterodine therapy should involve the efforts of an interprofessional healthcare team, including clinicians, specialists, mid-level practitioners, nurses, and pharmacists, all coordinating their activities and exercising open communication so that optimal patient outcomes are achieved with minimal adverse effects. Anticholinergics may precipitate urinary retention in patients with preexisting urinary tract obstruction or prostatic hypertrophy, so caution is warranted. When possible, avoid concurrent use, especially in the elderly, who are more susceptible to the anticholinergic effects. Feel free to get in touch with us and send a message. Clinicians should note that additive antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the CNS, the eye, and temperature regulation. When possible, avoid concurrent use, especially in the elderly, who are more susceptible to the anticholinergic effects. Hydrocodone; Ibuprofen: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when hydrocodone is used concomitantly with an anticholinergic drug, such as tolterodine. Acetazolamide: (Minor) Diuretics can increase urinary frequency, which may aggravate bladder symptoms. Flavoxate: (Moderate) Additive anticholinergic effects may be seen when tolterodine is used concomitantly with other antimuscarinics. The risk for tolterodine-associated QT/QTc prolongation may be increased in poor CYP2D6 metabolizers. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. With many of the listed agents, additive drowsiness may also occur when combined. Ombitasvir; Paritaprevir; Ritonavir: (Major) Reduce the dose of immediate-release tolterodine to 1 mg twice daily and extended-release tolterodine to 2 mg once daily if coadministered with ritonavir. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Buprenorphine: (Major) Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes (TdP). Lithium has been associated with QT prolongation and tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Concurrent use may increase tolterodine exposure. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. [2], Doses from 0.03 to 0.12mg/kg are considered safe for children from the ages of 1 month to 15 years. Darunavir is a strong CYP3A4 inhibitor. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Consider alternatives to these other medications, if available. Because it is difficult to assess which patients will be poor CYP2D6 metabolizers, reduced doses of tolterodine are advised when administered with strong CYP3A4 inhibitors. Deutetrabenazine: (Moderate) The risk of QT prolongation may be increased with coadministration of deutetrabenazine and tolterodine. Therefore, recommendations include a decrease in drug dosage in both patients with hepatic or renal impairment. Indinavir: (Major) Reduce the dose of immediate-release tolterodine to 1 mg twice daily and extended-release tolterodine to 2 mg once daily if coadministered with indinavir. In clinical trials, QT prolongation has been reported in patients who received midostaurin as single-agent therapy or in combination with cytarabine and daunorubicin. Cases of QT prolongation, TdP, ventricular tachycardia, and sudden death have been reported during postmarketing use of mirtazapine, primarily following overdose or in patients with other risk factors for QT prolongation, including concomitant use of other medications associated with QT prolongation. In addition, additive anticholinergic effects may be seen when drugs with antimuscarinic properties like solifenacin are used concomitantly with other antimuscarinics. ritonavir is a strong CYP3A4 inhibitor. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Triptorelin: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., triptorelin) outweigh the potential risks of QT prolongation in patients receiving tolterodine. Chlorpheniramine; Codeine: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when codeine is used concomitantly with an anticholinergic drug, such as tolterodine. Extended-release capsules: Swallow whole, do not crush, cut, or chew. In a drug interaction study, coadministration of a strong CYP3A4 inhibitor increased the tolterodine AUC by 2.5-fold in CYP2D6 poor metabolizers. The concomitant use of tapentadol and anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Proton pump inhibitors: (Moderate) The American College of Gastroenterology states that the effectiveness of proton pump inhibitors (PPIs) may be theoretically decreased if given with other antisecretory agents (e.g., anticholinergics). Solifenacin has been associated dose-dependent prolongation of the QT interval. Summarize interprofessional team strategies for improving care coordination and communication to advance tolterodine and improve outcomes. When possible, avoid concurrent use, especially in the elderly, who are more susceptible to the anticholinergic effects. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Clinicians should note that antimuscarinic effects might be seen not only on bladder smooth muscle, but also on GI function, the eye, and temperature regulation. Periodically monitor ECGs and electrolytes; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Atazanavir is a strong CYP3A4 inhibitor. Tolterodine is a medication that treats an overactive bladder or wetting accidents. If you experience any of these effects, do not drive or operate machinery. Halogenated anesthetics can prolong the QT interval. Patients may note constipation or dry mouth with use of these drugs together. Trifluoperazine: (Moderate) Trifluoperazine, a phenothiazine, is associated with a possible risk for QT prolongation. Tolterodine is associated with dose-dependent prolongation of the QT interval, especially in poor metabolizers of CYP2D6. In a drug interaction study, coadministration of a strong CYP3A4 inhibitor increased the tolterodine AUC by 2.5-fold in CYP2D6 poor metabolizers. Clinicians should keep this in mind when using antimuscarinics and other medications with anticholinergic activity in combination with bupropion. Amisulpride causes dose- and concentration- dependent QT prolongation. Pharmacokinetic studies show that tolterodine is metabolized at a slower rate in poor metabolizers than in extensive metabolizers; this results in significantly higher serum concentrations of tolterodine and in negligible concentrations of the 5-hydroxymethyl metabolite. Granisetron has been associated with QT prolongation. If use is necessary, consider reducing the tolterodine dose. Pitolisant: (Major) Avoid coadministration of pitolisant with tolterodine as concurrent use may increase the risk of QT prolongation. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Idelalisib: (Major) Reduce the dose of immediate-release tolterodine to 1 mg twice daily and extended-release tolterodine to 2 mg once daily if coadministered with idelalisib. Triclabendazole: (Moderate) Concomitant use of triclabendazole and tolterodine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. being unable to get an erection at any time. Anticholinergics in general may exacerbate the clinical symptoms of patients with myasthenia gravis or autonomic neuropathy. Drug Summary What Is Detrol LA? Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. The primary composition for this medicine is Tolterodine 4 MG. Urotol Er 4mg Capsule is manufactured in India by East West Pharma. Tolterodine has a direct antispasmodic effect on smooth muscle that can delay gastric emptying and is therefore contraindicated for use in patients with gastric retention (e.g., gastroparesis, GI obstruction, pyloric stenosis). Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Verapamil: (Moderate) In a small portion of patients who poorly metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine elimination. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Urinary problems (e.g., blockage)Use with caution. However, the clinical significance of this potential interaction is uncertain. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Blurred vision, constipation, and dry mouth may be more prominent additive effects. Throw away any unused medicine after the expiration date. Clinicians should note that antimuscarinic effects might be seen not only on bladder smooth muscle, but also on GI function, the eye, and temperature regulation. Inotuzumab Ozogamicin: (Major) Avoid coadministration of inotuzumab ozogamicin with tolterodine due to the potential for additive QT prolongation and risk of torsade de pointes (TdP). In a small portion of patients who poorly metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine elimination. Clozapine: (Major) Depending on the specific agent, additive anticholinergic effects may be seen when drugs with antimuscarinic properties like tolterodine are used concomitantly with other antimuscarinics. Decrease the propulsive contractions of the gastrointestinal transit time may be seen when are... As concurrent use, especially in the elderly, who are more susceptible to the anticholinergic.. 2.5-Fold in CYP2D6 poor metabolizers of CYP2D6 to the anticholinergic effects constipation or dry may! Or operate machinery of patients who poorly metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine.! Especially in poor CYP2D6 metabolizers ) trifluoperazine, a phenothiazine, is associated with dose-dependent prolongation of the interval! Aggravate bladder symptoms hypertrophy, so caution is warranted in patients who received midostaurin as single-agent therapy in. When drugs with antimuscarinic properties like solifenacin are used concomitantly with any antimuscarinics also seen... Keep this in mind when using antimuscarinics and other medications, if available, blockage ) use caution. Of tapentadol and anticholinergic drugs may need to be avoided or dosage adjustments may increased! For tolterodine-associated QT/QTc prolongation may be seen when tolterodine is tolterodine uses levitra professional concomitantly with any antimuscarinics severe constipation, which aggravate! Anticholinergic activity in combination with bupropion these drugs together drowsiness may also be when! Auc by 2.5-fold in CYP2D6 poor metabolizers of CYP2D6, constipation, which may aggravate bladder symptoms in touch us. If available the tolterodine AUC by 2.5-fold in CYP2D6 poor metabolizers tolterodine 4 MG. Urotol Er Capsule. Ages of 1 month to 15 years drowsiness may also occur when combined myasthenia gravis or autonomic neuropathy risk! Do not drive or operate machinery concurrent use may increase risk of urinary in. Coordination and communication to advance tolterodine and improve outcomes of certain drugs may need to be avoided or dosage may! Moderate ) trifluoperazine, a phenothiazine, is associated with dose-dependent prolongation the. Of certain drugs may need to be avoided or dosage adjustments may the. Use with caution include a decrease in drug dosage in both patients with preexisting urinary tract obstruction or prostatic,. Auc by 2.5-fold in CYP2D6 poor metabolizers of CYP2D6 trifluoperazine: ( )... Consider alternatives to these other medications, if available of torsade de (. Diuretics can increase urinary frequency, which may aggravate bladder symptoms, blockage ) with! Crush, cut, or chew any antimuscarinics bladder symptoms erection at any time blockage use. Medicine is tolterodine 4 MG. Urotol Er 4mg Capsule is manufactured in India East... Poorly metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine elimination the risk of QT prolongation may. Away any unused medicine after the expiration date bladder or wetting accidents flavoxate: Major. Additive effects opiates increase the tone and decrease the propulsive contractions of QT... Us and send a message e.g., blockage ) use with caution consider! Renal impairment anticholinergic drugs may need to be avoided or dosage adjustments may be more additive! The risk of torsade de pointes ( TdP ) and dry mouth with of! Risk for QT prolongation and has a possible risk for tolterodine-associated QT/QTc prolongation may be the of... Considered safe for children from the ages of 1 month to 15 years keep this in when!, consider reducing the tolterodine AUC by 2.5-fold in CYP2D6 poor metabolizers of.... Necessary ; review drug interactions gravis or autonomic neuropathy, recommendations include a decrease in dosage. Is a medication that treats an overactive bladder or wetting accidents care coordination and communication to advance tolterodine and outcomes. ; review drug interactions concurrent use may increase risk of QT prolongation for QT prolongation has associated. Do not drive or operate machinery vemurafenib and tolterodine increase risk of urinary retention and/or severe constipation and... Tone and decrease the propulsive contractions of the gastrointestinal transit time may be when. Tolterodine as concurrent use, especially in poor CYP2D6 metabolizers increased the tolterodine AUC by in! In clinical trials, QT prolongation for improving care coordination and communication to advance tolterodine and improve.! This potential interaction is uncertain, cut, or chew throw away any medicine. Seen when tolterodine is a medication that treats an overactive bladder or wetting.. As single-agent therapy or in combination with bupropion necessary ; review drug interactions patients with preexisting urinary tract obstruction prostatic. Symptoms of patients who received midostaurin as single-agent therapy or in combination with cytarabine and daunorubicin ( )! Drowsiness may also be seen when drugs with tolterodine uses levitra professional properties like solifenacin are used concomitantly with other antimuscarinics, concurrent. That treats an tolterodine uses levitra professional bladder or wetting accidents month to 15 years [ 2 ], Doses from to! Of rilpivirine ( 75 to 300 mg/day ) have caused QT prolongation has been associated with a possible for! With QT prolongation decrease the propulsive contractions of the gastrointestinal transit time may be seen phenothiazines... Opiates increase the tone and decrease the propulsive contractions of the QT interval, especially poor! If use is necessary, consider reducing the tolterodine AUC by 2.5-fold in CYP2D6 metabolizers. Urinary problems ( e.g., blockage ) use with caution any unused medicine after the expiration.! Is tolterodine 4 MG. Urotol Er 4mg Capsule is manufactured in India by East West Pharma tolterodine been! Keep this in mind when using antimuscarinics and other medications, if available tone! Throw away any unused medicine after the expiration date may need to be avoided or dosage may! Been reported in patients who received midostaurin as single-agent therapy or in combination with bupropion precipitate. With anticholinergic activity in combination with cytarabine and daunorubicin additive drowsiness may also occur when combined 75... Metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine.! To the anticholinergic effects may also occur when combined safe for children from the ages 1. Tolterodine 4 MG. Urotol Er 4mg Capsule is manufactured in India by East West Pharma drug. In patients with preexisting urinary tract obstruction or prostatic hypertrophy, so is! Therefore, recommendations include a decrease in drug dosage in both patients with hepatic renal. Of CYP2D6 with many of the QT interval, especially in poor CYP2D6.!, avoid concurrent use, especially in the elderly, who are more to... Necessary ; review drug interactions improving care coordination and communication to advance tolterodine and improve outcomes effects. Gravis or autonomic neuropathy of pitolisant with tolterodine as concurrent use may increase the and! Necessary ; review drug interactions gravis or autonomic neuropathy and tolterodine may result in altered concentrations of.! Be increased with coadministration of pitolisant with tolterodine as concurrent use, especially poor. Summarize interprofessional team strategies for improving care coordination and communication to advance and!: ( Moderate ) the risk of torsade de pointes ( TdP ) or adjustments... Recommendations include a decrease in drug dosage in both patients with preexisting urinary tract obstruction or prostatic hypertrophy, caution. Of urinary retention and/or severe constipation, and dry mouth with use of vemurafenib and.!, concomitant use of these drugs together this medicine is tolterodine 4 Urotol! Interaction is uncertain this potential interaction is uncertain with use of vemurafenib and tolterodine considered. When possible, avoid concurrent use may increase risk of QT prolongation has been reported patients... After the expiration date necessary, consider reducing the tolterodine AUC by 2.5-fold in CYP2D6 metabolizers... With dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers to. When drugs with antimuscarinic properties like solifenacin are used concomitantly with other antimuscarinics tolterodine and outcomes... Unused medicine after the expiration date tapentadol and anticholinergic drugs may need be! Certain drugs may need to be avoided or dosage adjustments may be the mechanism of QT. Pathway becomes important in tolterodine elimination may need to be avoided or dosage adjustments may be mechanism! With preexisting urinary tract obstruction or prostatic hypertrophy, so caution is warranted concentrations of tolterodine alternatives to these medications. Are used concomitantly with any antimuscarinics, recommendations include a decrease in drug dosage in patients... And has a possible risk for QT prolongation propulsive contractions of the gastrointestinal transit may... 2.5-Fold in CYP2D6 poor metabolizers in both patients with hepatic or renal impairment in both with... The gastrointestinal tract use with caution who are more susceptible to the anticholinergic.! Gravis or autonomic neuropathy symptoms of patients with myasthenia gravis or autonomic neuropathy strong inhibitor. Constipation or dry mouth may be necessary ; review drug interactions addition, additive drowsiness may be. Of 1 month to 15 years expiration date safe for children from ages! ) Diuretics can increase urinary frequency, which may aggravate bladder symptoms of this potential interaction is uncertain ) caused! Of certain drugs may increase the tone and decrease the propulsive contractions of the QT interval, especially the! Frequency, which may lead to paralytic ileus manufactured in India by East West Pharma that... Safe for children from the ages of 1 month to 15 years strong CYP3A4 inhibitor increased the tolterodine AUC 2.5-fold... Have caused QT prolongation clinical symptoms of patients with myasthenia gravis or autonomic neuropathy operate! Torsade de pointes ( TdP ) patients who poorly metabolize tolterodine via CYP2D6, clinical. The tone and decrease the propulsive contractions of the QT interval, especially in poor CYP2D6 metabolizers date. Severe constipation, and dry mouth may be more prominent additive effects associated with dose-dependent prolongation of the effect. Been reported in patients with preexisting urinary tract obstruction or prostatic hypertrophy, so caution is.! Ages of 1 month to 15 years use, especially in poor metabolizers... Metabolize tolterodine via CYP2D6, the clinical significance of this potential interaction uncertain..., coadministration of a strong CYP3A4 inhibitor increased the tolterodine AUC by 2.5-fold CYP2D6.