Medical term:

Toviaz


fesoterodine

(fee-soe-ter-o-deen) ,

Toviaz

(trade name)

Classification

Therapeutic: urinary tract antispasmodics
Pharmacologic: anticholinergics
Pregnancy Category: C

Indications

Treatment of overactive bladder function that results in urinary frequency, urgency, or urge incontinence.

Action

Acts as a competitive muscarinic receptor antagonist resulting in inhibition of cholinergically mediated bladder contraction.

Therapeutic effects

Decreased urinary frequency, urgency, and urge incontinence.

Pharmacokinetics

Absorption: Rapidly absorbed following oral administration, but is rapidly converted to its active metabolite (bioavailability of metabolite 52%); further metabolism occurs in the liver via CYP2D6 and CYP3A4 enzyme systems. 16% of active metabolite is excreted in urine, most of the remainder of inactive metabolites are renally excreted. 7% excreted in feces.
Distribution: Unknown.
Metabolism and Excretion: Rapidly converted by esterases to active metabolite.
Half-life: 7 hr (following oral administration).

Time/action profile (active metabolite)

ROUTEONSETPEAKDURATION
POrapid5 hr24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Urinary retention;Gastric retention;Severe hepatic impairment;Uncontrolled narrow-angle glaucoma.
Use Cautiously in: Significant bladder outlet obstruction (↑ risk of retention);Severe renal insufficiency (dose adjustment required);↓ GI motility including severe constipation;Treated narrow-angle glaucoma (use only if benefits outweigh risks);Myasthenia gravis;Severe renal impairment (dose should not exceed 4 mg/day); Geriatric: ↑ risk of anticholinergic side effects in patients >75 yr; Obstetric / Lactation: Avoid using unless potential benefits outweighs potential risk to fetus/neonate; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness
  • headache

Cardiovascular

  • tachycardia (dose related)

Gastrointestinal

  • dry mouth (most frequent)
  • constipation
  • nausea
  • upper abdominal pain

Genitourinary

  • dysuria
  • urinary retention

Musculoskeletal

  • back pain

Miscellaneous

  • angioedema (life-threatening)

Interactions

Drug-Drug interaction

Concurrent use of potent CYP3A4 enzyme inhibitors including ketoconazole, itraconazole, and clarithromycin ↑ blood levels and risk of toxicity; daily dose should not exceed 4 mg.Use less potent inhibitors of CYP3A4 (such as erythromycin ) with caution; escalate dose carefully.Anticholinergic effects may alter the GI absorption of other drugs.

Route/Dosage

Oral (Adults) 4 mg once daily initially may be ↑ to 8 mg/daily; Concurrent potent CYP3A4 inhibitors or CCr <30 mL/min—dose should not exceed 4 mg/day.

Availability

Extended-release tablets: 4 mg, 8 mg

Nursing implications

Nursing assessment

  • Assess for urinary urgency, frequency, and urge incontinence periodically throughout therapy.
  • Monitor for signs and symptoms of angioedema (swelling of face, lips, tongue, and/or larynx). May occur with first or subsequent doses. Discontinue therapy and prove supportive therapy. Have epinephrine, corticosteroids, and resuscitation equipment available.
  • Lab Test Considerations: May cause ↑ ALT and GGT.

Potential Nursing Diagnoses

Impaired urinary elimination (Indications)
Urinary retention (Indications)

Implementation

  • Oral: Administer without regard to food.
    • Extended-release tablets should be swallowed whole; do not break, crush, or chew.

Patient/Family Teaching

  • Instruct patient to take fesoterodine as directed. If a dose is missed, omit and begin taking again the next day; do not take 2 doses the same day. Advise patient to read the Patient Information sheet prior to initiation of therapy and with each Rx refill.
  • May cause drowsiness, dizziness, and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid alcohol; may increase drowsiness.
  • Advise patient to use caution in hot environments; may cause decreased sweating and severe heat illness.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise patient to stop medication and notify health care professional if signs and symptoms of angioedema occur.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decreased urinary frequency, urgency, and urge incontinence.
Drug Guide, © 2015 Farlex and Partners

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