Drug reference

Fesoterodine

Antimuscarinic · Urinary Antispasmodic

Also known as Fesoterodine fumarate, Toviaz

AntimuscarinicUrinary Antispasmodic

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

—

not curated

Top interactionssee all 12 →

AmprenavirSevereDatabaseDDInter
AtazanavirSevereDatabaseDDInter
BoceprevirSevereDatabaseDDInter
CeritinibSevereDatabaseDDInter

Mechanism

Fesoterodine is a prodrug that is rapidly and extensively hydrolyzed by non-specific plasma esterases to its active metabolite 5-hydroxymethyl tolterodine (5-HMT), which is a competitive muscarinic receptor antagonist with selectivity for M3 receptors in the bladder detrusor muscle. Unlike tolterodine, fesoterodine's activation does not depend on CYP2D6 polymorphisms, providing more predictable pharmacokinetics across patient populations. The extended-release formulation enables once-daily dosing for overactive bladder.

Indications

Urinary frequencyUrinary urgencyUrge incontinenceOveractive bladder syndrome (second-line treatment)Overactive bladderNeurogenic bladder

Dosing

Adult: 4 mg once daily, increased if necessary up to 8 mg once daily
Renal adjustment: Max 4 mg daily with concurrent use of potent inhibitors of CYP3A4. Avoid concurrent use with potent inhibitors of CYP3A4 if also having renal impairment.
Hepatic adjustment: Max 4 mg daily with concurrent use of potent inhibitors of CYP3A4. Avoid concurrent use with potent inhibitors of CYP3A4 if also having hepatic impairment.
Max dose: 8 mg once daily (general); 4 mg daily with concurrent use of potent inhibitors of CYP3A4

Contraindications

Concurrent use with potent inhibitors of CYP3A4 in patients with hepatic impairment
Concurrent use with potent inhibitors of CYP3A4 in patients with renal impairment