fesoterodine (Toviaz)

Introduction

FDA-approved 2008

Indications

• lower urinary tract symptoms (LUTS)
• urinary urgency & urinary frequency due to
  • urge incontinence, detrussor instability, overactive bladder

Contraindications

• severely reduced renal function (caution)
• urinary retention
• gastroparesesis (caution)
• uncontrolled narrow-angle glaucoma
• severe liver impairment

Dosage

• 4-8 mg PO QD
• do not exceed 4 mg in patients with renal insufficiency

Tabs: 4, 8 mg

Pharmacokinetics

• metabolized by cyt P450 3A4

Adverse effects

• common: dry mouth, constipation
• less frequent: dry eyes, urinary retention
• also see parasympatholytic

• drug adverse effects of parasympatholytics

Drug interactions

• levels increased by drugs that inhibit cyt P450 3A4 (ketoconazole)

• drug interaction(s) of parasympatholytic with parasympathomimetic

Mechanism of action

• anticholinergic, antimuscarinic agent
• relaxes smooth muscle of bladder
• prodrug of tolterodine

Notes

• improves urge incontinence & sleep quality in industry-sponsored study

More general terms

• urinary antispasmodic