Issues for surgery
Risk of increased urinary frequency, urgency and urge incontinence if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Post-operative advice
Restart post-operatively when next dose due.
Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.
Review appropriateness of continuing treatment if patient develops post-operative delirium.
Patients undergoing overactive bladder surgery
Review the need for festoferodine post-operatively.
Interactions with common anaesthetic agents
Antimuscarinic action
Antimuscarinic action may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Interactions with other common medicines used in the perioperative period
Prokinetics
Due to the effect of antimuscarinics on gastro-intestinal motility the effectiveness of prokinetic agents e.g. metoclopramide may be reduced.
Antimuscarinic action
Antiemetics
Antimuscarinic action may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
Antimuscarinic action may be additive with nefopam which also has antimuscarinic effects.
Antimicrobials
Clarithromycin (and to a lesser extent erythromycin) is predicted to increase the exposure of fesoterodine.
Whilst single surgical prophylactic doses should not pose a problem, consult product literature if continued post-operative treatment necessary as depending on the antimuscarinic concomitant use may be contraindicated or require dose reduction or monitoring for adverse effects.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 3rd February 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 3rd February 2021]
Summary of Product Characteristics – TOVIAZ® (fesoterodine) 4mg prolonged-release tablets. Pfizer Limited. Accessed via www.medicines.org.uk 06/11/2020 [date of revision of the text July 2019]