tolterodine
Regulatory sources consulted
Approved indications
- Symptomatic treatment of urge incontinence, urgency, and urinary frequency due to overactive bladder.
Contraindications
Absolute
- Urinary retention, uncontrolled narrow-angle glaucoma, myasthenia gravis, severe ulcerative colitis, toxic megacolon, or hypersensitivity.
Clinical warnings
- Major warning · It may prolong QT; use cautiously with long QT, electrolyte abnormalities, bradycardia, heart disease, or class IA/III antiarrhythmics. — CIMA/AEMPS, ficha técnica 77250
- Major warning · Monitor urinary retention, reduced gastrointestinal motility, and anticholinergic cognitive effects. — CIMA/AEMPS, ficha técnica 77250
Drug interactions
- HighStrong CYP3A4 inhibitors
Mechanism: They may markedly increase exposure, especially in CYP2D6 poor metabolizers, increasing overdose and QT risk.
Recommendation: Avoid systemic coadministration.
CIMA/AEMPS, ficha técnica 77250https://cima.aemps.es/cima/dochtml/ft/77250/FT_77250.html
- ModerateOther antimuscarinics
Mechanism: They increase anticholinergic effects.
Recommendation: Avoid unnecessary anticholinergic burden and monitor.
CIMA/AEMPS, ficha técnica 77250https://cima.aemps.es/cima/dochtml/ft/77250/FT_77250.html
Adverse events
Common (≥1%)
Dry mouth · Headache · Dyspepsia or constipation · Dizziness or drowsiness · Dry eyes or blurred vision
Rare but serious
Arrhythmia or heart failure · Angioedema or anaphylactoid reaction · Urinary retention · Confusion or hallucinations
Pregnancy and lactation
Not recommended during pregnancy and should be avoided while breastfeeding.
Recent literature (PubMed)
bladder based on a systematic review and network meta-analysis approach. Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software. A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache. Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.
The aim of this study was to indirectly compare the efficacy and safety of mirabegron and vibegron in patients with overactive bladder. A systematic search was performed on Pubmed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases to identify studies from the date of database inception to January 1, 2022. All randomized controlled trials comparing mirabegron or vibegron with tolterodine, imidafenacin, or placebo were eligible. One reviewer extracted data, and a second reviewer checked. Included trials were assessed for similarity, and networks were developed using Stata 16.0 software. Mean differences for continuous variables and odds ratios for dichotomous variables together with their 95% confidence intervals (CIs) were used to rank treatments and compare the differences, respectively. A total of 11 randomized controlled trials and 10 806 patients were included. For each outcome, results for all licensed treatment doses were included. Both vibegron and mirabegron were more efficacious than placebo at reducing the frequency of micturition, incontinence, urgency, urgency incontinence, and nocturia. Vibegron was more efficacious than mirabegron in reducing mean voided volume/micturition (95% CI [5.15, 14.98]). Safety outcomes for vibegron and mirabegron were similar to those in the placebo group, except for mirabegron, which had a higher risk of nasopharyngitis and cardiovascular adverse events than placebo. Both drugs seem to be comparable and well tolerated, particularly as direct comparisons are not available. However, vibegron may be more effective than mirabegron in reducing mean voided volume. RAB32-related Parkinson disease (PARK-RAB32) is clinically indistinguishable from Parkinson disease of unknown cause and is characterized by the cardinal motor manifestations of bradykinesia, rigidity, resting tremor, and postural instability. PARK-RAB32 may also be associated with non-motor features of Parkinson disease, such as olf