From the FDA Drug Label
The initial recommended dose of tolterodine tartrate tablets is 2 mg twice daily. The dose may be lowered to 1 mg twice daily based on individual response and tolerability. The maximum recommended dose of Tolterodine (Detrol) for treating overactive bladder is 2 mg twice daily 1.
From the Research
The maximum recommended dose of tolterodine (Detrol) for treating overactive bladder is 4 mg per day, administered as either 2 mg twice daily for immediate-release tolterodine or 4 mg once daily for extended-release tolterodine (Detrol LA). This recommendation is based on the study by 2, which indicates that tolterodine 4 mg/day is superior to placebo in improving micturition diary variables in patients with overactive bladder.
Key Considerations
- For patients with significant hepatic impairment or those taking potent CYP3A4 inhibitors, the maximum dose should be reduced to 1 mg twice daily for immediate-release or 2 mg once daily for extended-release formulations.
- Tolterodine works by blocking muscarinic receptors in the bladder, reducing involuntary bladder contractions and helping control symptoms of overactive bladder such as urgency, frequency, and urge incontinence.
- The medication typically takes 1-2 weeks to show initial improvement, with full effects often seen after 4-8 weeks of treatment, as supported by the study 3.
- Common side effects include dry mouth, constipation, headache, and dry eyes, with dry mouth being the most frequent adverse event, occurring in 28% of patients, as reported in the study 4.
- Patients should take the extended-release capsule whole with liquid and can take it with or without food.
Administration and Monitoring
- The study 5 suggests that the optimal dosage is 1 to 2 mg twice daily, irrespective of metabolic phenotype.
- The incidence of adverse events and improvements in micturition diary variables during open-label treatment were comparable with those observed during a 12 week randomized treatment, as seen in the study 4.
- The high proportion of patients remaining on treatment indicates that tolterodine is an effective long-term treatment for overactive bladder, with 70% of patients remaining on treatment for 9 months, as reported in the study 4.