Names and pronunciation
(fess′oh-ter-oh-deen) Toviaz
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Drug reference
(fess′oh-ter-oh-deen) Toviaz
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Func. class.: Overactive bladder product Func. class.: Antihistamine—2nd generation
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Chem. class.: Muscarinic receptor antagonist Chem. class.: Piperidine, peripherally selective
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ACTION: Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites ACTION: Acts on blood vessels, GI, respiratory system by competing with his- tamine for H1-receptor site; decreases allergic response by blocking pharmaco- logic effects of histamine, less sedating
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USES: Overactive bladder (urinary fre- quency, urgency), urinary incontinence USES: Rhinitis, allergy symptoms, chronic idiopathic urticaria
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CONTRAINDICATIONS: GI ob- struction, ileus, pyloric stenosis, urinary retention, gastric retention, hypersensitiv- ity, closed-angle glaucoma Precautions: Pregnancy, breastfeeding, children, renal/hepatic disease, urinary tract obstruction, ambient temperature increase, autonomic neuropathy, constipa- tion, contact lenses, hazardous activity, GERD, gastroparesis, myasthenia gravis, prostatic hypertrophy, toxic megacolon, ulcerative colitis, possible cross-sensitivity with tolterodine CONTRAINDICATIONS: Breast- feeding, newborn or premature infants, hypersensitivity Precautions: Pregnancy, children, geriatric patients, respiratory disease, closed-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, asthma, renal failure
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SIDE EFFECTS CNS: Insomnia, headache, dizziness CV: Chest pain, angina, QT prolongation, peripheral edema EENT: Xerophthalmia GI: Nausea, vomiting, abdominal pain, constipation, dry mouth GU: Dysuria, urinary retention, UTI INTEG: Rash, angioedema MISC: Peripheral edema, insomnia MS: Back pain RESP: Cough, URI SYST: Infection SIDE EFFECTS CNS: Headache, drowsiness, sedation, fatigue, blurred vision, paradoxical exci- tation in children or geriatric patients GI: Dyspepsia GU: Dysmenorrhea
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INTERACTIONS Increase: action of fesoterodine— CYP3A4 inhibitors (antiretroviral protease inhibitors, macrolide antiinfectives, azole antifungals), avoid use with doses >4 mg Increase: anticholinergic effect—anti- muscarinics, anticholinergics Increase: urinary frequency–diuretics Drug/Herb Decrease: fesoterodine—caffeine, green tea, guarana Drug/Food Increase: fesoteradine level–grapefruit juice Decrease: festerodine level–cola, coffee, tea Drug/Lab Increase: ALT, GGT INTERACTIONS Increase: fexofenadine effect—erythro- mycin, ketoconazole Decrease: fexofenadine effect—magne- sium-aluminum–containing antacids, rifAMPin Drug/Food Decrease: absorption of product—apple, orange, grapefruit juice Drug/Lab Test False negative: skin allergy tests
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TREATMENT OF OVERDOSE: Lavage, diazepam, vasopressors, IV phenytoin
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DOSAGE AND ROUTES • Adult and geriatric: PO EXT REL 4 mg/day, may increase to 8 mg/day, max 4 mg/day in those taking potent CYP3A4 inhibitors Renal dose • Adult: PO EXT REL CCr <30 mL/min, max 4 mg/day Hepatic Dose Adult: Child-Pugh C: Not recommended. DOSAGE AND ROUTES • Adult and child >12 yr: PO 60 mg bid or 180 mg/day • Child 2-11 yr: PO 30 mg bid • Child 6-11 yr: Child 6 mo-2 yr: PO 15 mg bid Renal dose • Adult and child ≥12 yr: PO CCr <80 mL/min, 60 mg/day initial • Child 2-11 yr: PO CCr <80 mL/min, 30 mg daily
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Available forms: EXT REL TABS 4, 8 mg Available forms: Tabs 30, 60, 180 mg; oral susp 6 mg/mL, orally disintegrating tab 30 mg; gel caps 180 mg
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Administer: • Do not break, crush, or chew ext rel product • Give without regard to meals • Store at room temperature; protect from moisture Administer: • Without regard to meals; caps/tabs should not be given with or right before grapefruit, orange, or apple juice Store in tight, light-resistant container • Orally disintegrating tab: allow to dis- solve, swallow; do not remove from blister pack until time of administration • Oral susp: shake well; use calibrated measuring device
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Assess: • Urinary patterns: distention, nocturia, frequency, urgency, incontinence • Allergic reactions: angioedema; swell- ing of face, tongue, throat may occur anytime during treatment; have emer- gency equipment nearby • Pregnancy/breastfeeding: no well- controlled studies; use only if benefits outweigh fetal risk Assess: • Allergy: itchy, runny, watery eyes; con- gested nose; before and during treatment • Bronchial secretions, lung sounds; in- crease fluids to 2000 mL/day unless contra- indicated to decrease thickness of secretions • Pregnancy/breastfeeding: no well- controlled studies; use only if benefits outweigh fetal risk
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Evaluate: • Therapeutic response: absence of uri- nary frequency, urgency, incontinence Evaluate: • Therapeutic response: absence of run- ning or congested nose or rashes
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CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid increased temperature, may decrease sweating • Not to drive or operate machinery until response is known • To avoid alcohol; drowsiness may occur • To report immediately allergic reac- tions including rash, swelling of mouth, face, lips, trouble breathing • Not to drink liquids before bedtime • About the importance of bladder main- tenance • Not to use new medications, herbs without prescriber approval F (fex-oh-fi′na-deen) Allegra Allergy Childrens, Allegra Allergy, Allergy 24-HR, Allergy Relief, Allergy Relief/Indoor/ Outdoor Patient and caregiver information: • About all aspects of product use; to notify prescriber if confusion, sedation, hypotension occur • To avoid driving, other hazardous ac- tivity if drowsiness occurs • To avoid alcohol, other CNS depressants • To take with water; avoid fruit juices as they may decrease effectiveness
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PHARMACOKINETICS Peak 5 hr, duration up to 24 hr, rapidly absorbed, protein binding 50%, excreted in urine/feces, half-life 7 hr metabolized by the liver (CYP2D6, CYP344 converted to active metabolite) PHARMACOKINETICS Well absorbed; onset 1 hr; peak 2-3 hr; duration 12-24 hr; 80% excreted in urine; feces 11%, half-life 14.5 hr, increased in renal disease
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• Adult and child >12 yr: PO 60 mg bid or 180 mg/day
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• Child 2-11 yr: PO 30 mg bid
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• Child 6-11 yr: Child 6 mo-2 yr: PO 15 mg bid Renal dose
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• Adult and child ≥12 yr: PO CCr <80 mL/min, 60 mg/day initial
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• Child 2-11 yr: PO CCr <80 mL/min, 30 mg daily
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