Fesoterodine (Toviaz®) has been launched as a new treatment for over-active bladder (OAB). Fesoterodine is a pro-drug of tolterodine.
The summary of product characteristics recommends a starting dose of 4mg daily with the option to increase to 8mg based on individual response. Dose restriction is recommended in renal and hepatic impairment and caution in use should be exercised in patients taking enzyme inhibitors.
A comparative study has assessed the efficacy of fesoterodine 4mg and 8mg in comparison to placebo and tolterodine 4mg modified release. The study found that fesoterodine was superior to placebo and equivalent to tolterodine. Drop out rates were similar in the 3 active treatment groups although dry mouth, constipation and dry eyes were more common in patients treated with fesoterodine.
Both strengths of fesoterodine will be available at £29.03 for 28 days supply; this is the same price as tolterodine 4mg modified release.
Action: Clinicians should be aware of this new drug. Given the similar efficacy to tolterodine, higher rate of side effects and black triangle status, use should be reserved to patients who have failed all other treatment options.