What is the role of tolterodine (Detrol) in the treatment of overactive bladder (OAB) in children?

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Tolterodine (Detrol), a nonselective antimuscarinic agent with a favorable tolerability profile compared with that of oxybutynin, has been studied in children. Tolterodine is metabolized in the liver, and the active metabolite has a therapeutic effect that is similar to that of oxybutynin. Because tolterodine is metabolized by the liver, care should be taken with agents that affect CYP2d6 and CYP3A4 activity, and practitioners should adjust dosage in patients with severe liver disease. Tolterodine is contraindicated in patients with urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, or documented hypersensitivity to the drug or its ingredients.

Safety and efficacy studies performed in European children on oral tolterodine doses ranging from 0.5 to 2.0 mg twice daily for 14 days demonstrated a 21% mean decrease from baseline in micturition frequency and a 44% mean decrease from baseline in the number of incontinence episodes among children who received the 1-mg dose. [32]

The efficacy of tolterodine in children has not been determined. The results of 2 pediatric phase III, placebo-controlled, double-blind, 12-week studies demonstrated aggressive, abnormal, and hyperactive behavior and attention disorder in 2.9% of children treated with Detrol LA compared with 0.9% treated with placebo. The most common adverse events were dry mouth, constipation, headache, vertigo/dizziness, and abdominal pain. Patients also reported abnormal vision (accommodation abnormalities), an expected side effect of an antimuscarinic agent.


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