1. About tolterodine
Tolterodine is a medicine used to treat symptoms of an overactive bladder. These can include:
- a sudden and urgent need to pee (urinary urgency)
- needing to pee more often than usual (urinary frequency)
- wetting yourself if you cannot make it to the loo in time (urinary incontinence)
It's also used to treat bedwetting in children (nocturnal enuresis).
Tolterodine works by relaxing the muscles around your bladder. This means your bladder can hold more liquid and you do not need to pee as often or as urgently.
Tolterodine is only available on prescription.
It comes as standard tablets and slow-release capsules (also called prolonged release or XL). This means the capsules release tolterodine slowly and evenly throughout the day.
2. Key facts
- You’ll usually take tolterodine tablets twice a day or slow-release capsules once a day.
- Tolterodine may take at least 4 weeks to reach its full effect. If the symptoms do not improve after 1 to 2 weeks, talk to your doctor.
- Your doctor will check after 2 to 3 months that tolterodine is still working and is the best treatment for you.
- Your doctor will also review every 6 to 12 months whether your treatment is still needed.
- Common side effects of tolterodine include a dry mouth or headache.
3. Who can and cannot take tolterodine
Tolterodine can be taken by most adults. It can also be taken by children aged 2 years and over, on the advice of their specialist.
Tolterodine is not suitable for some people. To make sure it's safe for you, tell your doctor or pharmacist before starting tolterodine if you:
- have ever had an allergic reaction to tolterodine or any other medicine
- have kidney or liver problems
- have myasthenia gravis, a condition that causes muscle weakness
- have glaucoma
- are not able to pee or empty your bladder completely (urinary retention)
- have a severe stomach or bowel condition, including a rare complication of ulcerative colitis or Crohn's disease called toxic megacolon
- have problems digesting food, or have severe constipation
- have heart problems, including long QT syndrome, heart failure, irregular or slow heartbeats or cardiomyopathy
- have a hiatus hernia
- have nerve damage that affects blood pressure, heart rate, sweating, pooing, peeing and digestion (autonomic neuropathy)
- have digestive problems such as heartburn and acid reflux
- are pregnant, trying to get pregnant or breastfeeding
4. How and when to take tolterodine
Always read the information that comes with your medicine.
Tolterodine capsules release the medicine evenly during the day. This means you do not need to take them as often as the standard tablets.
Swallow the tablets or capsules whole with a drink of water. Do not chew the capsules. You can take the tablets or capsules with or without food.
Dosage for tolterodine tablets
Adults will usually take 2mg in the morning and 2mg in the evening. Leave a gap of 12 hours between doses.
Children will usually take between 1mg and 4mg a day.
If you are giving tolterodine to a child to stop bedwetting, the usual dose is 1mg taken at bedtime. The dose can be increased up to a maximum of 2mg twice a day, depending on response.
If you have kidney or liver disease, or you're affected by side effects, your doctor may reduce your dose to 1mg twice a day.
Dosage for tolterodine slow-release capsules
The usual dose for adults taking slow-release tolterodine capsules is 4mg once a day.
Children will usually take between 1mg and 4mg a day.
If you have kidney or liver disease, or you're affected by side effects, your doctor may reduce your dose to 2mg once a day taken as tablets.
Take the capsule at the same time each day. This will help you to remember to take them.
What if I forget to take it?
If you forget to take a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just skip the missed dose and take your next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you. You could ask your pharmacist for advice on other ways to remember your medicines.
What if I take too much?
Taking 1 extra dose of tolterodine is unlikely to harm you.
However, you may get more side effects, such as a dry mouth or headache.
The amount of tolterodine that can lead to an overdose varies from person to person, and too much tolterodine can be dangerous.
Immediate action required: Call 999 or go to A&E if:
You've taken more than your usual dose of tolterodine and you have:
- a fast heartbeat
- breathing problems
Urgent advice: Contact 111 for advice now if:
You've taken 2 or more extra doses of tolterodine and you:
- have hallucinations
- feel very restless or excited
- have dilated pupils in your eyes
- are not able to pee
Call 111 or go to 111.nhs.uk
If you need advice for a child under the age of 5 years, call 111.
If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.
Bring the tolterodine packet or leaflet inside it, any remaining medicine, and any other medicines you take.
5. Side effects
Like all medicines, tolterodine can cause side effects, but not everyone gets them.
Common side effects
Keep taking tolterodine, but talk to your doctor or pharmacist if these side effects bother you or do not go away, or if you notice any other possible side effects.
Common side effects that may affect up to 1 in 10 people include:
- dry mouth
- headache
- feeling dizzy, sleepy, or a spinning sensation (vertigo)
- diarrhoea or being sick (vomiting)
- constipation
- farting and burping (wind)
- stomach pain
- dry eyes
- blurred vision
- problems or pain when peeing, and not being able to empty your bladder
Serious side effects
Serious side effects are rare.
Tell your doctor straight away if you have:
- stomach pain (especially after meals), feeling sick or being sick, a persistent urge to poo, not being able to poo or you have runny poos – these are all signs of faecal impaction, where large, hardened poo gets stuck and you cannot push it out
- difficulty fully emptying your bladder, or difficulty in starting to pee – these are signs of urinary retention, where pee builds up in your bladder because you're unable to pee
- high temperature or chills, burning sensation when peeing, pain in your back or side, or bloody or cloudy pee – these can be signs of a severe urinary tract infection (UTI)
- swollen ankles or legs (oedema) – where fluid builds up in your legs
Immediate action required: Call 999 or go to A&E if:
- you have chest pain – this can be a sign of heart rhythm problems (cardiac arrhythmia)
Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.
Bring all the medicines you take with you.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to tolterodine.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Do not drive yourself to A&E.
The person you speak to at 999 will give you advice about what to do.
These are not all the side effects of tolterodine. For a full list, see the leaflet inside your medicine packet.
Reporting side effects
You can report any suspected side effect using the Yellow Card safety scheme.
Visit the Yellow Card website for more information about reporting side effects.
6. How to cope with side effects of tolterodine
What to do about:
- dry mouth – try chewing sugar-free gum or having sugar-free sweets. Having a dry mouth can cause tooth decay or a fungal infection. It also might stop medicine that you put under your tongue from dissolving properly, such as medicine for angina.
- headache – make sure you rest and drink plenty of fluids. Avoid alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if your headache is severe or lasts longer than 1 or 2 days.
- feeling dizzy, sleepy or a spinning sensation – do not drive, cycle, use tools, or operate machinery. Avoid drinking alcohol, as this may make your symptoms worse. Talk to your doctor if the dizziness or sleepiness bothers you.
- diarrhoea or being sick – drink lots of water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee. Do not take any other medicines without speaking to a pharmacist or doctor, if the effects last more than 1 or 2 days. If you take the combined contraceptive pill or progestogen-only pill and you are sick, or have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.
- constipation – eat more high-fibre foods, such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to a pharmacist or doctor. Watch this short video about how to treat constipation.
- farting and burping – eat less foods that cause wind, like lentils, peas, beans and onions. It might also help to eat smaller and more frequent meals, eat and drink slowly, and exercise regularly. Ask your pharmacist about remedies you can buy to help with trapped wind.
- stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Try putting a heat pad or a covered hot water bottle on your stomach to help. If you are in a lot of sudden severe pain, speak to your pharmacist or doctor.
- dry eyes – ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and these become uncomfortable, you might have to wear glasses instead while you're taking this medicine.
- blurred vision – do not drive or ride a bike until you can see clearly again. Do not take your next dose of tolterodine if your vision is still blurred. Speak to your doctor or pharmacist if your vision has not returned to normal a day after taking your last dose.
- problems or pain when peeing – try to relax when you pee. Do not try to force the flow of urine. If it does not happen, try again later. Talk to a doctor urgently if you cannot pee at all
7. Pregnancy and breastfeeding
Tolterodine and pregnancy
Tolterodine is not usually recommended in pregnancy because there's not enough information available to say it's safe for you and your baby.
If you're trying to get pregnant or you're already pregnant, talk to your doctor about whether taking tolterodine is right for you.
Tolterodine and breastfeeding
Tolterodine is not usually recommended while breastfeeding. However, some breastfeeding mothers may still need it.
It is not known how much tolterodine gets into breast milk, but this is likely to be small.
If your doctor says it's OK for you to keep taking tolterodine, monitor your baby for possible side effects, such as constipation, peeing less and colic.
Talk to your doctor, midwife, or health visitor if you have any concerns about your baby while you're breastfeeding, including if you do not think your baby is putting on enough weight.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
For more information about treating bladder problems (urinary incontinence) during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.
8. Cautions with other medicines
Some medicines and tolterodine can affect each other. This can increase the chance of side effects.
Tell your doctor if you're taking:
- antibiotics like erythromycin or clarithromycin
- ketoconazole or itraconazole, which are used to treat fungal infections
- medicines used to treat HIV
- metoclopramide, used to increase how quickly you digest food
- amiodarone, sotalol, quinidine or procainamide, which are used to treat irregular heartbeats
- other medicines that work in a similar way to tolterodine, such as amantadine
Mixing tolterodine with herbal remedies and supplements
There might be a problem using herbal remedies and supplements while taking tolterodine.
Some herbal medicines can make you feel sleepy, cause a dry mouth, or make it difficult to pee. Their effect is similar to tolterodine. This can increase your risk of getting side effects or make your side effects worse.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about tolterodine
How does tolterodine work?
Tolterodine is a type of medicine called an antimuscarinic (or anticholinergic) muscle relaxant.
It works by relaxing the muscle that is found in the wall of the bladder. This helps to increase the volume of pee your bladder can hold and control the release of pee.
How long does it take to work?
Tolterodine begins to work within 3 to 8 hours but it may take up to 4 weeks before it takes full effect. If the symptoms do not improve after 1 to 2 weeks, talk to your doctor.
Talk to your doctor if your symptoms get worse at any time.
How long will I take it for?
Usually, you'll need to take tolterodine for a long time.
After 4 weeks your doctor will check that tolterodine is helping your symptoms. They'll also do a review every 6 to 12 months after that to check it's still working for you.
Take tolterodine until your doctor tells you to stop. Do not stop taking it just because you feel better.
Is it safe to take for a long time?
Do not take tolterodine for longer than you need to. Your doctor will check every 6 to 12 months that your treatment is still needed.
There may be an increased risk of confusion and possibly dementia in people taking tolterodine, but more study needs to be done. If you're worried about this, talk to your doctor.
Is it safe to take with painkillers?
It's safe to take tolterodine with everyday painkillers like paracetamol and ibuprofen.
Can I stop taking it?
If you want to stop taking tolterodine, talk to your doctor first.
If you've been taking it for at least 6 months, your doctor may suggest at your review that you can stop taking it for up to 4 weeks to see how your symptoms change without it.
Some people find that the improvement in their symptoms continues after they've stopped taking the medicine.
Are there other medicines for urinary incontinence and overactive bladder?
Tolterodine belongs to a group of medicines called antimuscarinics. There are other antimuscarinics that can be used for overactive bladder:
- solifenacin
- oxybutynin
- darifenacin
- fesoterodine
- propiverine
- trospium
They all seem to work just as well as tolterodine. However, if you get side effects with one antimuscarinic a different one may suit you better.
If antimuscarinics are unsuitable for you, they have not helped your overactive bladder, or you have had side effects, you may be offered a medicine called mirabegron, which works in a slightly different way.
Can I drink alcohol with it?
Try to avoid drinking alcohol when you first start taking tolterodine, or if your dose is increased, to see how you feel. Tolterodine combined with alcohol can make you feel very sleepy.
Drinking alcohol may make you more likely to need to get up in the night to pee.
Is there any food or drink I need to avoid?
You can eat normally while taking tolterodine. If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee and cola.
Will I gain or lose weight?
You may gain weight when you take tolterodine tablets. If you start to have problems with your weight while taking tolterodine, talk to your pharmacist or doctor.
Will it affect my contraception?
Tolterodine does not stop contraceptive pills working, including the combined pill or emergency contraception.
However, if tolterodine makes you sick or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
Find out more:
Will it affect my fertility?
There's no clear evidence to suggest that taking tolterodine will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.
Can I drive or ride a bike?
Do not drive a car, ride a bike, use tools or operate machinery if tolterodine makes you sleepy, gives you blurred vision, or makes you feel dizzy.
This may be more likely when you first start taking it, but could happen at any time, such as when starting another medicine.
Talk to a doctor or pharmacist if you're not sure whether it's safe for you to drive while taking tolterodine.
Are there lifestyle changes that can help overactive bladder?
There are a number of lifestyle changes that may help your symptoms. It's a good idea to:
- cut back on drinks that contain caffeine, such as tea, coffee and cola, as caffeine can increase how much you pee
- not drink too much or too little fluid during the day, as this can make incontinence worse
- lose weight if you are overweight or obese, as being overweight can increase your risk of urinary incontinence – use the BMI healthy weight calculator to find out if you're a healthy weight for your height
- try pelvic floor muscle training (Kegel exercises)
- try bladder training
- discuss other options for urinary incontinence with your doctor, such as surgery and procedures