An antimuscarinic for overactive bladder
Tolterodine
An antimuscarinic ('anticholinergic') medicine that calms an overactive bladder to reduce urgency and frequency; it can cause dry mouth and constipation.
What is Tolterodine?
Tolterodine is an antimuscarinic ('anticholinergic') medicine used to treat an overactive bladder, easing the sudden urges to pass urine, going often and urge leakage. It commonly causes dry mouth, constipation and blurred vision, and can cause confusion in older people. It is available as ordinary and modified-release forms.
Education and reference only. This is a plain-language guide to Tolterodine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Tolterodine is a 'bladder antimuscarinic' used in the UK to treat an overactive bladder — the syndrome of sudden, hard-to-defer urges to pass urine, going frequently, getting up at night and sometimes leaking before reaching the toilet. It is one of several similar medicines and is available as immediate-release tablets and as modified-release capsules taken once daily. It does not cure the bladder problem but reduces the symptoms while it is being taken, and is usually tried alongside bladder-training and lifestyle measures.
How it works
Tolterodine blocks muscarinic receptors on the bladder muscle. Normally the chemical messenger acetylcholine acts on these receptors to make the bladder muscle contract; by blocking them, tolterodine relaxes the bladder, allowing it to hold more comfortably and reducing the sudden urges and frequency of an overactive bladder. Because the same type of receptor is found elsewhere in the body, blocking it also causes the typical antimuscarinic side effects such as dry mouth, constipation and blurred vision.
Company & origin
Originated / developed by: Developed by Pharmacia (later part of Pfizer)..
Tolterodine was developed in Sweden and introduced in the late 1990s for overactive bladder.
What it treats
Conditions Tolterodine is used for
Practical use
How to take Tolterodine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it regularly as prescribed, alongside bladder-training and cutting down bladder irritants such as caffeine.
- Expect possible dry mouth, constipation and blurred vision; sips of water, sugar-free sweets and attention to fibre and fluids can help.
- Swallow modified-release capsules whole — do not open, crush or chew them.
- If you are older, be alert for new confusion or memory problems and report them, as antimuscarinics can contribute to this.
- Tell your prescriber about your other medicines, as several have similar drying or constipating effects that add up.
- Expect a review after a few weeks to check whether it is helping enough to continue.
Weighing it up
Advantages & disadvantages of Tolterodine
Advantages
- Effective at reducing urgency, frequency and urge leakage of an overactive bladder.
- Available as a convenient once-daily modified-release form.
- Works well alongside bladder-training and lifestyle measures.
Disadvantages
- Commonly causes dry mouth, constipation and blurred vision.
- Adds to anticholinergic burden and can cause confusion in older people.
- Does not cure the problem — symptoms return when it is stopped.
- Needs a review to confirm it is actually helping enough to justify the side effects.
Practical use
Good to know
It is an antimuscarinic ('anticholinergic') medicine, so it commonly causes dry mouth, constipation and blurred vision, and can make the eyes and mouth feel dry. In older people it adds to overall 'anticholinergic burden' and can cause or worsen confusion, so it is used carefully and reviewed. Modified-release capsules should be swallowed whole and not opened or crushed. It is usually tried alongside bladder-training and reducing bladder irritants such as caffeine, and is reviewed after a few weeks to check whether it is helping and worth continuing.
Who should not take it / use with caution
- People with urinary retention (difficulty emptying the bladder) or significant bladder outflow obstruction, where it can make emptying worse.
- People with untreated narrow-angle glaucoma, certain serious bowel conditions, or myasthenia gravis.
- Used with caution in older or frail people (added confusion and anticholinergic burden), significant liver or kidney impairment, and in pregnancy and breastfeeding.
Monitoring
- Review after a few weeks to check symptom benefit and tolerability.
- Watching for confusion in older people and for difficulty passing urine.
- Reviewing overall anticholinergic burden across all medicines.
Side effects
- Dry mouth and dry eyes.
- Constipation and indigestion.
- Blurred vision and dizziness or headache.
- Confusion, particularly in older people, and difficulty passing urine in those prone to retention.
Key interactions
- Other antimuscarinic or 'anticholinergic' medicines (some antihistamines, certain antidepressants, bladder and bowel medicines) — added dry mouth, constipation and confusion.
- Some medicines that affect liver enzymes can raise its levels and side effects.
- Medicines that affect heart rhythm may need consideration; tell your pharmacist about all your medicines.
Available as: Available as tablets and modified-release capsules.
Answers
Tolterodine: frequently asked questions
Why does tolterodine give me a dry mouth?
It is an antimuscarinic, so it blocks the same receptors that keep the mouth moist. Dry mouth is common; sips of water and sugar-free sweets can help.
Can older people take tolterodine?
Yes, but with caution, because antimuscarinics add to anticholinergic burden and can cause or worsen confusion. Any new confusion should be reported.
Can I open the modified-release capsules?
No. They should be swallowed whole and not opened, crushed or chewed, as this affects how the medicine is released.
Will it cure my overactive bladder?
No. It reduces symptoms while you take it but does not cure the problem, so symptoms tend to return if it is stopped.
How long before it works?
It may take a few weeks to judge the benefit, which is why a review is usually arranged to decide whether to continue.
The wider class
About Bladder antimuscarinics
Tolterodine belongs to the bladder antimuscarinics class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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