Detrol (tolterodine) is an antispasmodic medication used to treat an overactive bladder. This medication is also known as Detrusitol.

In reducing bladder muscle spasms, the medication helps patients regain control of:

• Urgent urination
• Frequent urination
• Incontinence
• Nighttime incontinence
• Waking up to urinate

Detrol generally should not be used in children. Not only can it be very difficult to distinguish between regular wetting and overactive bladder in younger patients, many studies of the medication have shown no benefit when compared to placebo. Seeking doctor advice is strongly encouraged before use in children, and a doctor will likely need to modify dosage.

This page is about the regular Detrol tablets, typically taken twice per day. Patients may also be interested in the extended-release version of Detrol, called Detrol XL, which is taken just once per day.

What to Expect from Detrol

This medication consists of film-coated tablets, which can be taken with or without food according to personal preference. A full glass of fluid is recommended with each dose.

Treatment in the majority of adults is quite similar:

• Take 2 mg twice per day.
• This dose is suitable for the vast majority of patients.
• Dosage may be adjusted, if needed, after a week or two of treatment.

Smaller doses of 1 mg twice per day are good for those who have kidney or liver impairment, or those on certain other medications, most notably those taking potent inhibitors of CYP3A4. These are:

• Antibiotics called clarithromycin or telithromycin;
• An antidepressant called nefazodone;
• Protease inhibitors (antivirals used to treat HIV or Hepatitis C) that end with -avir, such as ritonavir or tipranavir.

Some patients may notice improvements within taking the first few doses, but most will need to take the medication for a week or two to see full benefit. In reducing spasms in the bladder, urination should be less frequent and the urge to do so less severe. Most patients taking Detrol are better able to control urination, with fewer accidents and fewer incidences of waking up to urinate.

The need to continue treatment should be evaluated every three to six months.

Use in Children

In most places this medication is not approved for use in children. Some large studies, involving hundreds of children aged 5 to 10 years, found no difference between those on Detrol and those on placebo. There have been other studies in which Detrol did cause some improvement, but it was only marginally better than placebo.

Use of this product in children under age 16 should be done only with the approval and involvement of a doctor.

Potential Complications

Side effects from Detrol are typically mild, but rarely serious side effects can develop. Certain individuals are at increased risk of experiencing these severe side effects; Detrol should be used with caution in those who have:

• Difficulty or inability to urinate
• Gastrointestinal obstruction
• Kidney or liver impairment
• Hiatus hernia
• Autonomic neuropathy
• Glaucoma
• Decreased gastrointestinal motility
• Prolonged QT interval from any cause

The most common side effects associated with Detrol use are mild and often transient, meaning they stop occurring as the body adjusts to treatment. These side effects include:

• Dry mouth
• Dry eyes
• Blurred vision
• Mild stomach upset
• Joint pain
• Headache
• Constipation or diarrhea
• Mild drowsiness

Rarely more serious side effects develop. Seek medical attention if experiencing:

• Rapid or irregular heartbeat
• Chest pain
• Confusion
• Hallucinations
• Painful urination
• Difficult urination

Don't be afraid to ask a doctor about any concerning side effects, no matter how trivial they may seem.

Effects of Detrol on unborn or nursing babies are unknown; it hasn't been studied. In animal trials the medication did cause harm, however, so use of this medication while pregnant or breastfeeding is discouraged.

Detrol LA (tolterodine) is a medication used to help patients manage symptoms of an overactive bladder. The LA in this product stands for long-acting, meaning a tablet is taken just once per day, compared to twice-per-day dosing with regular Detrol.

Overactive bladder is usually caused by abnormal contractions, or spasms, of the bladder wall, known medically as detrusor overactivity. This action causes uncomfortable, disruptive, and sometimes embarrassing symptoms:

• Urgent urination
• Frequent urination
• Incontinence
• Nighttime incontinence
• Frequent waking up to urinate

Detrol LA works by relaxing the bladder wall, reducing the number and severity of spasms. Detrol LA works well, minimizing or completely eliminating symptoms, but it is not a cure; symptoms will most likely return when treatment ends unless other corrective action has been taken.

While Detrol LA use has not been studied well in patients under age 16, regular-acting versions of the active ingredient did not produce significant benefit in young patients, and did produce a slightly greater-than-usual incidence of side effects. One can therefore conclude, at least until when/if more studies are done, that risks are not worth the benefits in young patients under age 16.

Dosage & Administration

Detrol LA comes in tablets, either 2 mg or 4 mg doses. Tablets must not be split, chewed, crushed, or otherwise damaged; doing so destroys the long-acting effect and may deliver too much medication.

Treatment is simple:

• Take 4 mg once per day.
• This dose is suitable for the vast majority of patients.
• Depending on preexisting conditions or other medications, dosage may be started at 2 mg; likewise patients who experience side effects at 4 mg may have dosage lowered to 2 mg.
• Do not exceed 4 mg per day without explicit doctor approval.
• Treatment may continue for as long as needed; however, treatment should stop every three to six months to see if it's still needed.

The majority of patients find symptoms greatly improved, with less urgency, reduced frequency, better sleep with fewer interruptions, and less incidences of incontinence.

While some benefit may be seen with the first few doses, it can take a week or two for full benefit to be seen. Patients should continue taking Detrol LA for at least a week before passing judgement. If no benefit at all is seen after a week, alternative methods should be considered; it's possible the overactive bladder symptoms are not caused by bladder spasms.

Better Bladder Control

The medication is effective for the majority of overactive bladder sufferers, to at least some degree; many patients find symptoms completely eliminated, while others will find some symptoms persist but they're very significantly reduced. However, it is not a cure and other strategies will be needed to resolve the condition without the need for medication.

Patients with overactive bladder are often encouraged to utilize other methods of regaining bladder control; two of the more popular methods are:

• Pelvic floor therapy, in which a patient practices kegel exercises to strengthen the pelvic muscles;
• Bladder retraining, in which urination takes place on a schedule whether one needs to urinate or not.

Both methods can prove beneficial in helping patients reduce frequency, urgency, and incontinence. While these, or similar, exercises may be enough for some patients to eliminate reliance on medications, others are not so lucky and may need to resort to surgery if all else fails.

Detrol versus Detrol LA

While Detrol LA is certainly convenient---taken just once per day---some patients find taking two smaller doses of regular Detrol to be more effective. Detrol LA also cannot be split or crushed like regular tablets, which can be a problem for those who have difficulty swallowing whole pills.

Treatment with Detrol LA usually consists of:

• Take 4 mg once per day.

And with regular Detrol:

• Take 2 mg twice per day.

If unsure which formulation works best, it's easy enough to swap between the two to find out; simply stop taking the old tablet and the next day start taking the new tablet. Note, however, that it can take a week or two for full benefit to be seen and evaluated; give each tablet a couple of weeks before passing judgement.

Important Precautions

Detrol LA may not be the best choice for individuals with certain preexisting conditions. While it doesn't necessarily mean it can't be taken, dosage will likely be reduced to 2 mg per day if there is a history of:

• Difficulty or inability to urinate
• Gastrointestinal obstruction
• Kidney or liver impairment
• Hiatus hernia
• Autonomic neuropathy
• Glaucoma
• Decreased gastrointestinal motility
• Prolonged QT interval from any cause

Likewise in those who are taking potent inhibitors of CYP3A4, which are:

• Antibiotics called clarithromycin or telithromycin;
• An antidepressant called nefazodone;
• Protease inhibitors (antivirals used to treat HIV or Hepatitis C) that end with -avir, such as ritonavir or tipranavir.

Don't be afraid to ask a doctor about any concerning side effects, no matter how trivial they may seem.

Detrol XL (tolterodine ER) is a convenient, once-per-day medication that treats overactive bladder. The XL in this product's name stands for extended-release, compared to regular Detrol tablets, which are taken twice per day.

This product is also known as Detrusitol XL or Incont LA.

Detrol XL is not suitable for children under 16 years of age. Studies have found no improvement to marginal improvement in younger patients given this medication when compared to placebo; risks are generally not worth the benefits.

Taking Detrol XL

Detrol XL reduces muscle spasms in the bladder, which in turn reduces the urgency and frequency of urination. It's often used to reduce or eliminate:

• Urgent urination
• Frequent urination
• Incontinence
• Nighttime incontinence
• Waking up to urinate

XL tablets, since they're extended-release, must be swallowed whole; they shouldn't be split, crushed, or chewed. Taking them with food is optional, but a full glass of fluid is recommended with each dose. Treatment is similar in otherwise healthy adults:

• Take 4 mg once per day.
• This dose is suitable for the vast majority of patients.
• Do not exceed 4 mg per day without explicit doctor approval.

Some patients are at increased risk of severe side effects from Detrol XL; these patients will need a half-dose:

• Take 2 mg once per day.

Note that if the appropriate dosage is not available on this page it might be found on the regular Detrol tablets page. Dosage will be reduced and frequency will be increased to twice per day with regular tablets.

It might take a couple of weeks of treatment for patients to see significant improvement, though some individuals notice benefit sooner. The need to continue treatment should be evaluated every three to six months.

Most patients find the medication helps reduce the urgency and frequency of urination, preventing embarrassing accidents, improving sleep, and generally improving quality of life.

Precautions & Side Effects

Side effects from Detrol XL are typically mild, but, rarely, serious side effects can develop. Certain individuals are at increased risk of experiencing these severe side effects; Detrol XL should be used with caution in those who have:

• Difficulty or inability to urinate
• Gastrointestinal obstruction
• Kidney or liver impairment
• Hiatus hernia
• Autonomic neuropathy
• Glaucoma
• Decreased gastrointestinal motility
• Prolonged QT interval from any cause

The medication can interact with a number of other medications. Of most concern are potent inhibitors of CYP3A4, which are:

• Antibiotics called clarithromycin or telithromycin;
• An antidepressant called nefazodone;
• Protease inhibitors (antivirals used to treat HIV or Hepatitis C) that end with -avir, such as ritonavir or tipranavir.

Patients taking the above medications or who have any of the conditions listed before them may not be suitable for Detrol XL use, or will require modified dosage of 2 mg once per day.

Serious side effects which require urgent medical attention include:

• Rapid or irregular heartbeat
• Chest pain
• Confusion
• Hallucinations
• Painful urination
• Difficult urination

Don't be afraid to ask a doctor about any concerning side effects, no matter how trivial they may seem.

Effects of Detrol XL on unborn or nursing babies are unknown; it hasn't been studied. In animal trials the medication did cause harm, however, so use of this medication while pregnant or breastfeeding is discouraged.