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Home > Drug Category > Overactive Bladder Medication > Toviaz and Equivalent

Toviaz Information

Toviaz (Fesoterodine Fumarate) is an antimuscarinic medication used to treat two primary conditions related to bladder dysfunction. It is primarily used in adults to treat overactive bladder, a condition characterized by a sudden, uncontrollable need to urinate, frequent trips to the bathroom, and urge urinary incontinence, which is involuntary urine leakage. Also, it is used in children to treat neurogenic detrusor overactivity, a condition in which neurological disorders, such as spina bifida or spinal cord injuries, cause the bladder muscle to contract erratically. It is typically used in children aged six years and older who weigh more than 25 kilograms.

Toviaz works by blocking acetylcholine, a chemical messenger, from binding to specific muscarinic receptors on the surface of the muscle cells. Once ingested, its active ingredient, fesoterodine fumarate, is rapidly hydrolyzed by body esterases into its principal active metabolite, 5-hydroxymethyl tolterodine (5-HMT), which targets the bladder's detrusor muscle. Normally, acetylcholine signals this muscle to squeeze and empty the bladder. By preventing acetylcholine-mediated activation of this muscle, Toviaz helps suppress premature, involuntary bladder wall contractions. This appears to stabilize the bladder wall, allowing the muscle to relax and hold a larger volume of urine, which ultimately reduces the sudden, intense urge to urinate.

Toviaz Side Effects

Because muscarinic receptors are located throughout the body (not just in the bladder), blocking them causes classic systemic anticholinergic side effects.

Common side effects include dry mouth, dry eye, constipation, difficulty digesting food (dyspepsia), straining or pain when emptying the bladder, dizziness, headache, stomach pain, diarrhea, nausea, difficulty sleeping, and dry throat. Contact your doctor if these mild side effects persist or worsen.

Stop taking this medication and seek immediate medical attention if you notice signs of an allergic reaction, such as breathing difficulties, a rash, itching, hives, blistering of the skin, or swelling of the face, lips, tongue, or throat. Ensure you inform your doctor about any other side effects you notice that are not listed here.

Toviaz Precautions

Do not use this medication if you experience, or have a history of, any of the following conditions:
• A known hypersensitivity or allergy to fesoterodine, tolterodine, or any other ingredients in Toviaz;
• Delayed stomach emptying (gastric retention);
• Difficulty passing urine or severe urinary retention;
• Moderate or severe hepatic (liver) or renal (kidney) impairment while concurrently taking potent CYP3A4 inhibitors (such as certain antifungal or antiviral medications);
• Myasthenia gravis;
• Severe gastrointestinal problems such as severe ulcerative colitis, toxic megacolon or other inflammatory bowel diseases and complications;
• Severe liver impairment (Child-Pugh Class C);
• Uncontrolled narrow-angle glaucoma;

This medication may require dosage adjustments under certain conditions. Therefore, before starting this medication, ensure that you inform your doctor about any prior or current medical conditions, including the following:
• Autonomic neuropathy;
• Controlled narrow-angle glaucoma;
• Decreased bowel movement or severe constipation;
• Electrolyte imbalances such as low potassium levels in the blood (hypokalemia);
• Heartburn, acid reflux, or dyspepsia (including a history of hiatal hernia);
• Heart disease, including a history of structural heart issues, congestive heart failure, or a family history of an abnormal heart rhythm called long QT syndrome;
• Kidney disease;
• Liver disease;
• Mild delay in bladder emptying, probably from conditions like mild benign prostatic hyperplasia (an enlarged prostate);
• Urinary tract infection;

Some medications such as ketoconazole, itraconazole, clarithromycin, and nefazodone can drastically elevate the concentration of fesoterodine's active metabolite due to their potent inhibitory effects on the liver's CYP3A4 metabolism enzyme, therefore potentially causing severe adverse effects. Also, concomitant use of Toviaz with other drugs possessing prominent anticholinergic properties, including tricyclic antidepressants like amitriptyline, and sedating first-generation antihistamines like diphenhydramine, can heavily increase the severity of side effects like severe dry mouth, constipation, blurred vision, and urinary retention. Therefore, before using this medication, inform your doctor about any other medications you are currently taking, including herbal medicines and supplements, to determine if it is safe to use along with Toviaz.

Clinical data on the use of Toviaz during pregnancy are highly limited, but animal studies suggest potential toxicity to the fetus at very high doses, meaning it should only be used if the potential benefits to the mother clearly outweigh the fetal risk. It remains unknown whether the medication or its active metabolite is excreted into human breast milk or affects the nursing infant. However, because anticholinergic drugs can potentially suppress prolactin production and decrease maternal milk supply, caution is advised. Do not stay too long in hot weather or saunas, and avoid overheating during exercise or other strenuous activities, as this medication can reduce sweating and increase the risk of heatstroke (hyperthermia). Store this medication at room temperature, protect it from moisture, and keep it out of reach of children.

Do I need a prescription to order Toviaz?

Yes, a prescription is required from your physician to order Toviaz.