Tolterodine is a competitive muscarinic receptor antagonist that was developed for the management of OAB. There are currently two oral formulations: an immediate-release (Detrol) available in 1- and 2-mg tablets given twice per day, and an extended-release pill available as 4mg given once per day (Detrol LA; Pfizer, Inc., New York, NY).
Tolterodine immediate-release has consistently demonstrated a 20% reduction in micturition episodes, and a 40% to 60% reduction in weekly urge incontinence episodes versus placebo in randomized, double-blind, placebo-controlled studies.810
The mechanism of action is similar to oxybutynin, but the adverse side-effect profile is improved. The better tol-erability profile of tolterodine compared with immediate-release oxybutynin has been confirmed in two randomized studies of detrusor overactivity. In a meta-analysis including 1120 patients, Appell11 reported severe xerostomia in 6% of placebo, 4% of the 2-mg tolterodine arm, 17% of the 4-mg tolterodine arm, and 60% of the 15-mg immediate-release oxybutynin arm.
Extended-release tolterodine (Detrol LA) is a once-daily dosage that utilizes a microsphere system to deliver a more uniform serum concentration. Van Kerrebroeck et al.12 demonstrated in a phase III study that Detrol LA was statistically superior to Detrol in terms of tolerability, namely, xerostomia (P < .02), whereas maintaining similar efficacy in significantly reducing mean urge incontinence episodes per week and mean micturition frequency.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.