Fesoterodine
TOVIAZ
What it isMuscarinic antagonist, a prodrug converted by esterases to the active metabolite of tolterodine; overactive bladder.
Why this oneEsterase activation avoids CYP2D6-dependent drug formation, making conversion more consistent than tolterodine's.
What limits itAnticholinergic burden as for the class. Renally adjusted.
FDA-approved for
- overactive bladder (2008)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Overactive bladder | adult | 4 mg QD | 8 mg QD |
Renal CLcr <30 mL/min: maximum 4 mg QD.
Hepatic Undefined
Instructions
- Swallow whole with liquid; do not chew, divide, or crush.
- Take with or without food.
Contraindications
- Urinary retention
- Gastric retention
- Uncontrolled narrow-angle glaucoma
Cautions
- Angioedema (may occur after first or later doses)
- Urinary retention in bladder outlet obstruction
- Decreased GI motility (avoid in severe constipation)
- Worsening of narrow-angle glaucoma
- CNS effects/somnolence
- Worsening of myasthenia gravis
Adverse reactions
- Dry mouth
- Constipation
Pregnancy No human data; fetotoxicity in animal studies.
Lactation No information on presence in human milk.
NO BOXED WARNINGS
Principal riskAnticholinergic burden
Cost, est. cash$300–$2,500/month
Generic entry2015
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Active metabolites
Mechanism of action: Fesoterodine ballicule
Open Fesoterodine in the interactive console ↗
Memory aids: mascots and interaction avatars
“Red as a beet” → antimuscarinic
