Tolterodine (Detrusitol)

Tolterodine is used in the treatment of bladder symptoms when you need to go to the toilet urgently or frequently.

Tolterodine is taken by mouth (orally) as tablets, usually twice a day. It can be taken before, during or after a meal.

You may not see an immediate effect when you first start taking tolterodine. Your bladder will need some time to adapt. It usually starts to have an effect within four weeks. Tolterodine can affect the amount of urine that stays in your bladder and monitoring this before starting on medication is important. It is normal for a small amount to be retained, but the risk of urinary tract infections (UTIs) is increased if too much urine remains in the bladder.

Results vary from person to person, and often depend on how severe your symptoms were initially.

If tolerated, the medication should be taken for a month so your doctor can assess how effective the treatment is for you. You should then be reassessed again after a few months. If there is no noticeable improvement the medication should be stopped.

The side effects from tolterodine can include:

• dry mouth
• headache
• dry eyes
• constipation
• hot flushes or facial flushing

Sucking sugar free sweets or ice cubes, or chewing sugarless gum can help alleviate a dry mouth. Saliva substitutes can also help, these can be purchased over the counter in pharmacies.

Dry eyes only usually occur for a short period, but using eye drops may help if this is a problem.

If you experience headache, initially you could try taking paracetamol regularly.

If constipation is an issue, try to make sure you're drinking plenty of fluids - around eight cups per day is recommended. A mild laxative, such as Sennakot, may help over the initial period. Also increasing the amount of soluble fibre in your diet, such as oats and oat bran, beans and peas, barley, rye and flax seed, or fruit such as bananas, pears and apples, and root vegetables (preferably without the skins), can help.

Ensuring your room is well ventilated, and wearing cotton nightwear and using cotton bedsheets, can help reduce the effects of hot flushes and facial flushing.

Tolterodine isn't recommended if you're pregnant or breastfeeding. You shouldn't take this medication if you're being treated for glaucoma until it's established whether you have wide or narrow angle glaucoma and it's been confirmed it's safe for you to take.

A small study in 2018 found that tolterodine may worsen cognitive function in people with MS, in particular it may affect processing speed and memory.

You should avoid, or stop taking this medication if you:

• experience changes in your vision
• have severe abdominal pain or cramps
• cannot pass urine or find it difficult to urinate
• experience a new onset of lower back pain
• experience palpitations
• feel dizzy or faint
• notice changes in your cognitive function or experience increased confusion

You should stop taking tolterodine immediately if you experience swelling of the face or tongue and a rash, and consult the person who prescribed the medication.

Tolterodine is a type of drug called an anticholinergic. These drugs block the action of the neurotransmitter (chemical messenger) acetylcholine, which transfers messages including those that start bladder contractions. It is used to try and reduce how frequently you need to empty your bladder, the sensation of urgently needing to go to the toilet and urinary incontinence. Day and night-time leaks should reduce or even stop completely.

Tolterodine is also classed as an antispasmodic, so it also works to relax the muscles of the bladder wall, which in turn helps improve your ability to control your bladder.

• EMC: Patient Information leaflets for tolterodine