What is the recommended treatment plan for patients with overactive bladder symptoms using Toviaz (fesoterodine)?

From the Guidelines

The recommended treatment plan for patients with overactive bladder symptoms using Toviaz (fesoterodine) typically begins with a starting dose of 4 mg once daily, which can be increased to 8 mg once daily based on individual response and tolerability, as suggested by the most recent guidelines 1.

Key Considerations

• The medication should be taken with water and can be administered with or without food.
• Patients should swallow the extended-release tablet whole without crushing or chewing it.
• Treatment duration is generally long-term as overactive bladder is often a chronic condition, with regular follow-up evaluations every 3-6 months to assess efficacy and side effects.
• Toviaz works by blocking muscarinic receptors in the bladder, reducing involuntary detrusor muscle contractions and improving symptoms such as urgency, frequency, and urge incontinence.

Important Side Effects and Interactions

• Patients should be advised about common side effects including dry mouth, constipation, and headache.
• For optimal results, Toviaz should be combined with behavioral modifications such as scheduled voiding, fluid management, and pelvic floor exercises.
• Dose adjustments may be necessary for patients with renal or hepatic impairment, with a maximum recommended dose of 4 mg daily for those with significant renal insufficiency or moderate hepatic impairment, as per the guidelines 1.

Additional Guidance

• The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder emphasizes the importance of shared decision-making to select the best therapy or therapies, regardless of invasiveness, based on the patient’s needs, desires, and side effect tolerance 1.
• Telemedicine is a viable option for patients with OAB; however, it will not allow for all elements of the initial in-office evaluation, and urinalysis can be obtained at a local laboratory or by review of recent lab results 1.

From the Research

Treatment Plan for Overactive Bladder Symptoms using Toviaz (Fesoterodine)

• The recommended treatment plan for patients with overactive bladder symptoms using Toviaz (fesoterodine) involves taking the medication as prescribed by a doctor, typically starting with a dose of 4mg once daily 2.
• Fesoterodine has been shown to be effective in reducing episodes of accidental urination and improving quality of life for patients with overactive bladder symptoms 2.
• Compared to other anticholinergic drugs, such as tolterodine, fesoterodine may have a higher risk of withdrawal due to adverse events and dry mouth, but may also have superior efficacy 3.
• The choice of anticholinergic drug and dose should be individualized based on the patient's specific symptoms, medical history, and tolerance to side effects 3.
• Mirabegron, a β3-adrenergic receptor agonist, may be considered as an alternative to antimuscarinics, such as fesoterodine, for older patients or those with certain comorbidities, due to its different tolerability profile and lower risk of anticholinergic burden 4.
• Combination therapy with mirabegron and solifenacin may provide additional benefits for patients with overactive bladder symptoms, but may also increase the risk of certain side effects, such as constipation and dry mouth 5, 6.

Dosage and Administration

• The recommended starting dose of fesoterodine is 4mg once daily, which can be increased to 8mg once daily if needed and tolerated 2, 3.
• Fesoterodine should be taken orally with water, and can be taken with or without food 2.
• Patients should be advised to swallow the tablet whole and not to crush or chew it 2.

Monitoring and Follow-up

• Patients taking fesoterodine should be monitored regularly for efficacy and tolerability, and dose adjustments should be made as needed 2, 3.
• Patients should be advised to report any side effects, such as dry mouth, constipation, or urinary retention, to their doctor promptly 2, 3.
• Regular follow-up appointments with a doctor are recommended to assess the patient's response to treatment and make any necessary adjustments to the treatment plan 2, 3.