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.