Questions About Detrol and Detrol L.A. (Tolterodine tartrate)

These days, we are bombarded with advertisements for prescription drugs. Many of our patients are taking these drugs. As chiropractors, we need to be informed about prescription drugs so we can educate our patients about their effects, side effects and dangers, as well as suggest safer alternatives when appropriate. (Don't count on their medical doctor or pharmacist to fully inform them.)

Detrol and Detrol L.A. are prescribed for the treatment of overactive bladder. Pfizer manufactures both. Pfizer reported total company sales of $47-49 billion in 2008, of which $1.2 billion came from sales of Detrol and Detrol L.A.¹ CVS pharmacy in Bozeman, Mont., where I practice, charges $135.99 for a 30-day supply (4 mg tablets) of Detrol L.A.

Detrol is a muscarinic receptor antagonist; it works by competing for receptor sites, effectively inhibiting the action of acetylcholine, which inhibits contraction of the detrusor muscle that empties the bladder. Acetylcholine is the neurotransmitter found at all parasympathetic and sympathetic preganglionic synapses and at all parasympathetic postganglionic synapses. Detrol inhibits the parotid gland from secreting saliva, which explains why dry mouth is a side effect (see below). We might also speculate that other parasympathetic functions like digestion might be inhibited.

Potential Side Effects

Pfizer's information Web site reports side effects from Detrol/Detrol L.A. including dry mouth, headache, constipation, abnormal vision, abdominal pain and aggravation of the symptoms of dementia including confusion, disorientation and delusions in patients taking cholinesterase inhibitors for the treatment of dementia.²

In her book Our Daily Meds, Melody Peterson cites two case studies in which Detrol caused severe dementia.³ In the book, she says she considers overactive bladder to be a "disease" created by the pharmaceutical industry marketing department, rather than one discovered by researchers or scientists.

Dr. Jack Tsao, lead researcher of a new study funded by the National Institute on Aging, warns, "It may be better to use a diaper and think clearly than the other way around." He reported in the study that patients using anti-cholinergic drugs had a 50 percent faster rate of cognitive decline than those who were not.⁴

Natural Alternatives

Avoiding diuretics like caffeine and alcohol, engaging in regular exercise and doing Kegel exercises are helpful in maintaining bladder control. Instructions for Kegel exercises, developed by Dr. Arnold Kegel and also known as pelvic floor training, can be found online.⁵

Certainly chiropractic adjustment to the pelvis and low back can have an effect on the pudendal nerves that arise from the second, third and fourth sacral segments and control bladder function. In children whose sacral segments have yet to fuse, subluxation of the individual sacral segments can compromise the pudendal nerves. Sadly, my research revealed that medical doctors are prescribing Detrol to small children for bed-wetting. In my experience, childhood bed-wetting can be easily resolved by adjusting the individual sacral segments.⁶

References

1. Pfizer Annual Review 2008: Key Medicines and Their Performance.
2. Patient information on Detrol. Available on the Pfizer Web site.
3. Peterson M. Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. Sarah
4. Crighton Books, Farrar, Straus and Giroux, New York, 2008.
5. "Incontinence Meds May Impair Thinking." FiercePharma.com, April 18, 2008.
6. "Kegel Exercises: How to Strengthen Pelvic Floor Muscles. MayoClinic.com.
7. Hough D. "Case Management of Nocturnal Enuresis." Today's Chiropractic, July/Aug 2001.