Tolterodine

Clinical data
Trade names	Detrol, Detrusitol, others
Other names	PNU-200583E
AHFS/Drugs.com	Monograph
MedlinePlus	a699026
License data	US DailyMed: Tolterodine
Pregnancy category	AU: B3
Routes of administration	By mouth
ATC code	G04BD07 (WHO)
Legal status
Legal status	AU: S4 (Prescription only) CA: ℞-only UK: POM (Prescription only)[1] US: ℞-only[2][3] EU: Rx-only[4]
Pharmacokinetic data
Bioavailability	77%
Protein binding	Approximately 96.3%
Elimination half-life	1.9–3.7 hours
Identifiers
IUPAC name (S)-2-[3-(Diisopropylamino)-1-phenylpropyl]-4-methylphenol
CAS Number	124937-51-5 Y as salt: 124937-52-6
PubChem CID	443879 as salt: 443878
IUPHAR/BPS	360
DrugBank	DB01036 Y as salt: DBSALT000467
ChemSpider	391967 Y as salt: 391966
UNII	WHE7A56U7K as salt: 5T619TQR3R
KEGG	D00646 Y as salt: D01148
ChEBI	CHEBI:9622 Y as salt: CHEBI:32245
ChEMBL	ChEMBL1382 Y as salt: ChEMBL1200871
CompTox Dashboard (EPA)	DTXSID3023687
ECHA InfoCard	100.232.068
Chemical and physical data
Formula	C22H31NO
Molar mass	325.496 g·mol−1
3D model (JSmol)	Interactive image
SMILES Cc1ccc(c(c1)[C@H](CCN(C(C)C)C(C)C)c2ccccc2)O
InChI InChI=1S/C22H31NO/c1-16(2)23(17(3)4)14-13-20(19-9-7-6-8-10-19)21-15-18(5)11-12-22(21)24/h6-12,15-17,20,24H,13-14H2,1-5H3/t20-/m1/s1 Y Key:OOGJQPCLVADCPB-HXUWFJFHSA-N Y
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Tolterodine, sold under the brand name Detrol among others, is a medication used to treat frequent urination, urinary incontinence, or urinary urgency.^[5] Effects are seen within an hour.^[6] It is taken by mouth.^[6][7]

Common side effects include headache, dry mouth, constipation, and dizziness.^[6] Serious side effects may include angioedema, urinary retention, and QT prolongation.^[6] Use in pregnancy and breastfeeding are of unclear safety.^[5][8] It works by blocking muscarinic receptors in the bladder thus decreasing bladder contractions.^[6]

Tolterodine was approved for medical use in 1998.^[6] It is available as a generic medication.^[5] In 2020, it was the 271st most commonly prescribed medication in the United States, with more than 1 million prescriptions.^[9][10]

Medical uses

Detrusor overactivity (DO, contraction of the muscular bladder wall) is the most common form of urinary incontinence (UI) in older adults.^{[medical citation needed]} It is characterized by uninhibited bladder contractions causing an uncontrollable urge to void.^{[medical citation needed]} Urinary frequency, urge incontinence and nocturnal incontinence occur.^{[medical citation needed]} Abnormal bladder contractions that coincide with the urge to void can be measured by urodynamic studies.^{[medical citation needed]} Treatment is bladder retraining,^{[11][unreliable medical source?]} pelvic floor therapy or with drugs that inhibit bladder contractions such as oxybutynin and tolterodine.^{[medical citation needed]}

Side effects

Known side effects:

• Dry mouth
• Decreased gastric motility (upset stomach)
• Headache
• Constipation
• Dry eyes
• Sleepiness
• Urinary retention

The following reactions have been reported in people who have taken tolterodine since it has become available:

• Allergic reactions including swelling
• Rapid heartbeat or abnormal heartbeat
• Accumulation of fluid in the arms and legs
• Hallucinations

Tolterodine is not recommended for use in people with myasthenia gravis and angle closure glaucoma.

Pharmacology

Tolterodine acts on M₂ and M₃^[12] subtypes of muscarinic receptors whereas older antimuscarinic treatments for overactive bladder act more specifically on M₃ receptors.^{[medical citation needed]}

Tolterodine, although it acts on all types of receptors, has fewer side effects than oxybutynin (M₃ and M₁ selective, but more so in the parotid than in the bladder) as tolterodine targets the bladder more than other areas of the body.^{[medical citation needed]}

Society and culture

Brand names

It is marketed by Pfizer in Canada and the United States under the brand name Detrol. In Egypt it is also found under the trade names Tolterodine by Sabaa and Incont L.A. by Adwia.