Editing Functional: Pharmacological Management of LUTS (section)

====== Tolterodine (Detrol) ======
* '''Metabolism: extensively metabolized by the liver (cytochrome P450) into its major active metabolite 5-HMT''' 
** '''5-HMT has''' '''a similar pharmacologic profile as the mother compound and significantly contributes to the therapeutic effect of tolterodine.'''
**'''5-HMT is metabolized in the liver, but a significant part of 5-HMT is excreted renally without additional metabolism'''
* '''Selectivity:''' tissue selective (has selectivity for the bladder compared with the salivary gland) but no selectivity for muscarinic receptor subtypes.
* Dosing: Available in immediate release and extended release formulations. The extended release form seems to have advantages over the immediate release form in terms of both efficacy and tolerability
* Outcomes: significant improvement in frequency and incontinence episodes
* Adverse events:
** No effect on QT interval
** '''Low incidence of cognitive effects''' (relatively low lipophilicity of tolterodine and even lesser one of 5-HMT imply limited propensity to penetrate into the CNS)
*Estimated cost per month: 35$ USD[https://www.goodrx.com/]