| Medication | Starting dose | Maximum dose | Selected characteristics |
Darifenacin extended-release
(7.5 and 15 mg tablets) | 7.5 mg orally once daily | 15 mg orally once daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (19 to 35%) and constipation (15 to 21%) are common
- Metabolized in liver by CYP3A4; maximum 7.5 mg daily with strong CYP3A4 inhibitors*
- Reduced dose for moderate hepatic impairment
- Not recommended for severe hepatic impairment
|
Fesoterodine extended-release
(4 and 8 mg tablets) | 4 mg orally once daily | 8 mg orally once daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (19 to 35%) and constipation (4 to 6%) are common
- Metabolized in liver by CYP3A4; maximum 4 mg daily with strong CYP3A4 inhibitors*
- Reduced dose for severe renal impairment
- Not recommended for severe hepatic impairment
|
Oxybutynin immediate-release
(5 mg tablet) | 5 mg orally 2 or 3 times daily | 5 mg orally 4 times daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (71%) and constipation (9%) are common
- Dizziness (17%) and somnolence (14%) can occur
- Often not tolerated by older adults and medically ill patients due to anticholinergic (including CNS) side effects
- Reduced dose in older adults
- Short effect may be useful when continence is desired at specific times
- Compliance is difficult with frequent dosing
|
Oxybutynin extended-release
(5, 10, and 15 mg tablets) | 5 to 10 mg orally once daily | 30 mg orally once daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (35%) and constipation (9%) are common
- Somnolence (6%) can occur
- Compliance is improved with daily dosing
|
Oxybutynin transdermal
(10% gel sachet [packet] or pump) | Apply 1 sachet (packet) or 1 pump once daily; each packet or pump delivers 1 g of gel equivalent to 100 mg oxybutynin | Same as starting dose | - Refer to "General antimuscarinic issues" below this table
- Associated with low rates of dry mouth (2 to 12%) and constipation (1%)
- Apply to clean, dry, intact skin on abdomen, thighs, or upper arms/shoulders
- Keep area dry for at least 1 hour after application
- Do not use same application site more than once in 7 days
- Application site reaction including irritation and dermatitis (up to 14%)
|
Oxybutynin transdermal
(3.9 mg patch) | Apply 1 patch twice per week (ie, once every 3 to 4 days) | Do not exceed starting dose | - Refer to "General antimuscarinic issues" below this table
- Available without a prescription (OTC) in the United States and some other countries
- Associated with low rates of dry mouth (10%) and constipation (3%)
- Apply under clothing to abdomen, hip, or buttock
- Do not use same application site more than once in 7 days
- Application site pruritus (14 to 17%); local erythema (8%), rash (3%)
|
Solifenacin
(5 and 10 mg tablets | 5 mg orally once daily | 10 mg orally once daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (11 to 28%) and constipation (5 to 13%) are common
- Reduce dose for severe renal impairment or moderate hepatic impairment
- Not recommended for severe hepatic impairment
- Metabolized in liver by CYP3A4; maximum 5 mg daily with CYP3A4 inhibitors*
- Modestly prolongs QTc interval; caution with other QTc prolonging drugs* and in patients with congenital prolonged QT
|
Tolterodine extended-release
(2 and 4 mg tablets) | 2 mg orally once daily | 4 mg orally once daily | - Refer to "General antimuscarinic issues" below this table
- Dry mouth (23 to 35%) and constipation (6 to 7%) are common
- Reduced dose for renal and/or hepatic impairment, not recommended for severe renal or hepatic impairment
- Metabolized in liver by CYPs 3A4 and 2D6; maximum 2 mg daily with strong CYP3A4 inhibitors*
- Modestly prolongs QTc interval; caution with other QTc prolonging drugs* and in patients with congenital prolonged QT
|
Tolterodine immediate-release
(1 and 2 mg tablets) | 1 mg orally twice daily | 2 mg orally twice daily |
Trospium extended-release
(60 mg tablet) | 60 mg orally once daily | Same as starting dose | - Refer to "General antimuscarinic issues" below this table
- Need to take on empty stomach or 1 hour before meal
- Dry mouth (9 to 22%) and constipation (9 to 10%) are common
- Reduce dose for renal impairment, not recommended for severe renal impairment
- Not metabolized by CYP and therefore has a low risk of drug-drug interactions
- Avoid alcohol consumption within 2 hours of using extended-release preparation
|
Trospium immediate-release
(20 mg tablet) | 20 mg orally once daily | 20 mg twice daily |
