Warfarin Institute of America
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TOLTERODINE INTERACTIONS WITH WARFARIN
Colucci and Rivey published the reports of two cases of men 72 and 83 years of age who had INRs go to 6.1 and 7.4 respectively. These levels were reached after 10 to 14 days of tolterodine being added to warfarin. In the first case, when the tolterodine was stopped, the warfarin dose returned to where it had been for the previous year. In the second case, a very similar course was reported.
One person reported to me via e-mail that she was having a hard time getting her warfarin dose regulated. She stated that she took tolterodine on as needed basis. I recommended that she take it daily, but did not have any reply from her.
In the previously mentioned article, the authors mention that Pharmacia-Upjohn (as of 11-04 this would be Pfizer), the marketers of Detrol, had received six reports of this interaction occurring by the time the article was written in November 1998.
It would appear wise to check the INR of someone taking warfarin who is started on tolterodine after one week of therapy. Likewise, is someone is stopping tolterodine and continuing warfarin, it seems reasonable to check the INR after one week. Also, since many people will probably take this drug on an as needed basis, it should be investigated as a possible source of fluctuating INRs.
Reference: Colucci VJ, Rivey MP. Tolterodine-warfarin drug interaction. Ann Pharmacother 1999 Nov;33(11):1173-6
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Last updated November 21, 2004