Tolterodine: Superior tolerability than and comparable efficacy to oxybutynin in individuals 50 years old or older with overactive bladder: A randomized controlled trial

Purpose: We compared the tolerability and clinical efficacy of tolterodine with those of oxybutynin in patients with an overactive bladder using an up ward oxybutynin dose titration strategy analogous to that used in routine c linical practice in the United Kingdom and Republic of Ireland, Materials and Methods, In a randomized double-blind trial 378 male and fema le patients 50 years old or older with symptoms of overactive bladder ia ur inary frequency of 8 or more voids per 24 hours with urgency and/or urge in continence, that is 1 or more urge incontinence episodes per 24 hours) rece ived 10 weeks of treatment with 2 mg. tolterodine twice daily/or an initial dose of 2.5 mg, oxyloutynin twice daily, increasing to 5 mg, twice daily a fter 2 weeks of treatment. The main outcome measures were changes in voidin g diary variables combined with detailed tolerability-safety; assessments. Results: Patients treated with tolterodine had significantly fewer adverse events (69% versus 81%, p = 0.01), notably dry mouth (37% versus 61%, p <0. 0001), as well as a lower incidence of dose reduction (6% versus 25%, p <0. 0001) than those in the oxybutynin group, Each agent had comparable efficac y for improving urinary symptoms. Tolterodine and oxybutynin caused a signi ficant decrease (p = 0.0001) in the mean number of voids per 24 hours (-1.7 or -15% and - 1.7 or - 15%, respectively), urge incontinence episodes per 24 hours (- 1.3 or - 54% and -1.8 or -62%, respectively) and mean voided vo lume per void (33 mi, or 22% and 34 ml, or 23%) after 10 weeks of treatment . Conclusions: Tolterodine is as effective as oxybutynin for improving the sy mptoms of overactive bladder but it has superior tolerability, The combinat ion of these qualities makes tolterodine the preferred pharmacological ther apy for the long-term treatment of this condition.