Storage
lower urinary tract symptoms (LUTS) in men are usually chronic, with a high prevalence and a substantial impact on quality of life; therefore, adequate
therapies are desirable and crucial for these men. First line treatment for all patients with storage LUTS should always be behavioral. The gold standard for pharmacological treatment of
overactive bladder/storage symptoms is a
muscarinic receptor antagonist such as
tolterodine. First-marketed
antimuscarinics were limited by several adverse events such as dry mouth,
constipation,
tachycardia, accommodation disorder, and
cognitive dysfunction, resulting in poor compliance and early treatment discontinuation in a large number of patients. In order to improve compliance with oral drug treatment,
tolterodine was developed, providing a better efficacy/adverse event profile.
Tolterodine is available in the following two formulations: the intermediate release (IR) and extended release form (ER).
Tolterodine ER 4 mg administered once daily is pharmacokinetically equivalent to
tolterodine IR 2 mg twice daily but has a lower incidence of adverse events and increased efficacy. Combination
therapy of
tolterodine and an alpha-blocker is significantly more efficacious than either monotherapy. Even when compared and added to
tamsulosin,
tolterodine shows a good safety profile. The incidence of acute
urinary retention requiring catheterization and treatment withdrawals due to adverse events are low in all the studies included in the present review.