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. 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