Drug interactions
Physostigmine + Tolterodine
Severity: Moderate
Physostigmine 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
Physostigmine inhibits acetylcholinesterase and increases cholinergic tone, directly opposing the antimuscarinic action of tolterodine. The result may be reduced efficacy of one or both drugs. Physostigmine is mostly used in acute anticholinergic toxicity.
What this interaction means in plain words
Physostigmine 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.
Why it happens
Pharmacodynamic antagonism between cholinesterase inhibition and muscarinic receptor blockade.
What to do
Expect reduced effect of tolterodine and reassess symptoms. When physostigmine is used for anticholinergic overdose, monitor for bradycardia and cholinergic effects.
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
Frequently asked questions
Can I take Physostigmine with Tolterodine?
MediHelp rates the interaction as moderate. Physostigmine 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. Physostigmine inhibits acetylcholinesterase and increases cholinergic tone, directly opposing the antimuscarinic action of tolterodine. The result may be reduced efficacy of one or both drugs. Physostigmine is mostly used in acute anticholinergic toxicity.
How serious is the interaction between Physostigmine 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: Expect reduced effect of tolterodine and reassess symptoms. When physostigmine is used for anticholinergic overdose, monitor for bradycardia and cholinergic effects.
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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