Drug interactions
Neostigmine + Tolterodine
Severity: Moderate
Neostigmine and Tolterodine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Neostigmine increases acetylcholine at muscarinic receptors, while tolterodine blocks them, so each can reduce the effect of the other. This may blunt the intended effect of neostigmine on gut or bladder motility, and the net effect is hard to predict.
What this interaction means in plain words
Neostigmine and Tolterodine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Neostigmine belongs to Central Nervous System; Tolterodine belongs to Genitourinary.
Why it happens
Pharmacodynamic antagonism between a cholinesterase inhibitor and a muscarinic antagonist.
What to do
Monitor the clinical response to neostigmine, such as bowel or bladder function or neuromuscular strength. Adjust or stop tolterodine if it undermines the therapeutic goal.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Tolterodine
Other interactions of Neostigmine
Frequently asked questions
Can I take Neostigmine with Tolterodine?
MediHelp rates the interaction as moderate. Neostigmine and Tolterodine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Neostigmine increases acetylcholine at muscarinic receptors, while tolterodine blocks them, so each can reduce the effect of the other. This may blunt the intended effect of neostigmine on gut or bladder motility, and the net effect is hard to predict.
How serious is the interaction between Neostigmine and Tolterodine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor the clinical response to neostigmine, such as bowel or bladder function or neuromuscular strength. Adjust or stop tolterodine if it undermines the therapeutic goal.
What other medicines interact with Tolterodine?
MediHelp also lists interactions of Tolterodine with, for example, Clarithromycin, Clozapine, Cobicistat. The full list is on the Tolterodine page.
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