Toviaz (Fesoterodine) - Oral

What Is Toviaz?

Toviaz (fesoterodine) is a muscarinic receptor antagonist (MRA) that blocks the activity at muscarinic receptors in bladder smooth muscle to treat overactive bladder (OAB).

Toviaz is also used in neurogenic detrusor overactivity (NDO), a bladder dysfunction disorder, in children 6 years and older.  

Toviaz works by blocking the activity of the neurotransmitter acetylcholine. When these receptors are activated, they cause contraction of bladder smooth muscle, resulting in the desire to urinate. Taking fesoterodine results in fewer receptors available to be activated by acetylcholine and a decrease in bladder smooth muscle contraction.

Toviaz is available by prescription as an oral tablet.

Drug Facts

Generic Name: Fesoterodine

Brand Name(s): Toviaz

Drug Availability: Prescription

Therapeutic Classification: Muscarinic receptor antagonist

Available Generically: Yes

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Fesoterodine fumarate

Dosage Form(s): Tablet

What Is Toviaz Used For?

The Food and Drug Administration (FDA) approved Toviaz to treat adults with OAB who experience symptoms of urge urinary incontinence (leaking urine), urgency (sudden desire to pass urine), and frequency (the need to urinate more frequently).

It is also approved to treat pediatric NDO in children 6 years and older and weighing more than 55 pounds. In NDO, there is an overactivity of the bladder wall muscle. This condition also causes similar symptoms to OAB but typically results from a disease or injury to the nervous system.

How to Take Toviaz

Follow your healthcare provider’s instructions for taking Toviaz. You may take it with or without food. Swallow tablets whole and do not crush, chew, or divide tablets.

Storage

Store at room temperature (between 68 F and 77 F) and protect from light and moisture. Keep the medication out of reach of children and pets to prevent accidental consumption.

How Long Does Toviaz Take to Work?

You may start to see improvement in your OAB symptoms within a few weeks of starting fesoterodine. However, feeling the maximum benefits can take up to 12 weeks.

What Are the Side Effects of Toviaz?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider or a pharmacist. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects associated with taking Toviaz include:

  • Dry mouth
  • Constipation
  • Diarrhea
  • Nausea
  • Abdominal pain
  • Headache
  • Urinary tract infection
  • Weight gain

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:

Long-Term Side Effects

In long-term extensions of clinical trials that lasted up to three years, side effects possibly related to fesoterodine included:

  • Urinary retention
  • Diverticulitis, which causes left-sided stomach pain, usually after eating
  • Constipation
  • Irritable bowel syndrome, a functional gastrointestinal disorder that causes crampy stomach pain, bloating, constipation, or diarrhea
  • QTc interval prolongation, an irregularity in the electrical activity of the heart

Report Side Effects

Toviaz may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Toviaz Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For neurogenic detrusor overactivity:
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor.
        • Weighing more than 35 kilograms (kg)—At first, 4 milligrams (mg) once a day. Your doctor may increase the dose to 8 mg once a day after 1 week.
        • Weighing more than 25 and up to 35 kg—At first, 4 mg once a day. Your doctor may increase the dose as needed and tolerated. However the dose is usually not more than 8 mg once a day.
      • Children younger than 6 years of age or weighing 25 kg or less—Use and dose must be determined by your doctor.
    • For symptoms of an overactive bladder:
      • Adults—At first, 4 milligrams (mg) once a day. Your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 8 mg once a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Certain factors may affect your use or dosage of Toviaz, such as:

  • Pregnancy: The safety of using fesoterodine in pregnancy has not been established. There is no published human experience with fesoterodine in pregnancy to determine if it is linked to major birth defects, miscarriage, or adverse maternal and/or fetal outcomes. However, some animal studies have shown adverse effects.
  • Breastfeeding: It is not known if Toviaz is excreted in human breast milk. There is no published human experience of lactation with Toviaz. Taking Toviaz while lactating may decrease milk supply by reducing serum prolactin and inhibiting oxytocin and growth hormone secretion.
  • Adults 75 and older: In clinical trials, there was no observed difference in efficacy in older adults compared to younger people. However, in adults 75 years and older, the incidence of anticholinergic side effects (e.g., dry mouth, constipation, dyspepsia, increase in residual urine, dizziness) was higher than in younger adults.
  • Kidney problems: You may need a lower dose if you have severe kidney problems. It might also be necessary to lower the dose or stop treatment in children 6 years and older who weigh more than 77 pounds and have severe kidney problems.

Missed Dose

If you miss a dose of Toviaz, skip the missed dose and take the next dose at your usual time the next day. Do not double up on the medication to make up for a missed dose.

Overdose: What Happens If I Take Too Much Toviaz?

Overdose with Toviaz can result in severe anticholinergic side effects. Overdoses of Toviaz should be treated symptomatically. Electrocardiogram (ECG) monitoring is recommended.

Overdose symptoms may include:

  • Drowsiness
  • Flushing
  • Fever
  • Dry mouth
  • Rapid heartbeat
  • High blood pressure
  • Nausea or vomiting
  • Agitation
  • Confusion
  • Hallucinations

What Happens If I Overdose on Toviaz?

If you think you or someone else may have overdosed on Toviaz, call your healthcare provider or the Poison Control Center. 

If someone collapses or isn’t breathing after taking Toviaz, call 911.

Precautions

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It is very important that your doctor check your progress at regular visits to see if the medicine is working properly and to check for unwanted effects.

This medicine may cause a serious allergic reaction, called angioedema, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs after using this medicine.

This medicine may increase your risk of having urinary retention (trouble passing urine or not fully emptying the bladder). Check with your doctor if you have a decrease in urine volume, decrease in the frequency of urination, difficulty in passing urine (dribbling), or painful urination.

This medicine may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking this medicine, since overheating may result in heat stroke.

Avoid drinking alcohol while you are taking this medicine.

This medicine may cause some people to become dizzy, drowsy, or have blurred vision. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause dryness of the mouth, nose, and throat. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Toviaz?

Do not take Toviaz if you have:

  • Hypersensitivity to fesoterodine or any of the ingredients in Toviaz
  • Urinary retention
  • Gastric retention (delayed or slow emptying of the stomach)
  • Uncontrolled narrow-angle glaucoma

What Other Medications Interact With Toviaz?

Before starting Toviaz, tell your healthcare provider about any other medications you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Toviaz can interact with:

Antimuscarinic Drugs

Taking Toviaz with other antimuscarinic drugs may increase the incidence and severity of anticholinergic side effects like dry mouth, constipation, and urinary retention. For this reason, it's not advised to take these medications at the same time.

CYP3A4 Inhibitors

Taking fesoterodine with a strong CYP3A4 inhibitor increases the plasma concentration of fesoterodine by approximately double. For adults, limit doses of fesoterodine to 4 milligrams in these cases. It is not recommended for children taking strong CYP3A4 drugs to use fesoterodine. If you are unsure whether you are currently taking any CYP3A4 inhibitors, share your list of medications with a healthcare provider or pharmacist.

This is not a complete list of interactions, and others may occur. Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Toviaz.

What Medications Are Similar?

Toviaz is a muscarinic receptor antagonist used to treat OAB. Other MRAs used to treat OAB include:

People generally only take one MRA for OAB at a time, as taking more than one increases the incidence of side effects.

Frequently Asked Questions

  • How does Toviaz work?

    Toviaz and other MRAs work by blocking the effects of the neurotransmitter acetylcholine on bladder smooth muscle contractions, thereby decreasing symptoms of OAB.

  • What side effects can I expect while taking Toviaz?

    The most common side effect of Toviaz reported during clinical trials was dry mouth, and it was more common with the higher dose of 8 milligrams (35%) compared to the 4-milligram dose (19%) and placebo (7%). The second most common side effect was constipation (4% to 6%) compared with 2% in the placebo group.

  • How long does Toviaz take to work?

    Most people noticed an improvement in symptoms within one to two weeks after starting Toviaz. If you don’t see any improvement in OAB symptoms after being on this medication for 12 weeks, talk to your healthcare provider about adjusting your dose or trying a different medication.

How Can I Stay Healthy While Taking Toviaz?

Toviaz can improve symptoms of OAB but commonly causes dry mouth and constipation. Drink water regularly and eat a diet rich in fiber to ease constipation. 

Toviaz can also cause drowsiness, dizziness, and blurred vision. Do not drive or do activities that require alertness until you know how it affects you. Furthermore, alcohol can enhance the drowsiness caused by Toviaz. 

Stay in contact with your healthcare provider after starting medications for OAB. You may need a dosage adjustment or try different medications if symptoms do not improve after one to two months. It can also be beneficial to familiarize yourself with non-drug lifestyle factors and tips to help you cope with OAB.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Toviaz label.

  2. Mansfield KJ. Role of fesoterodine in the treatment of overactive bladder. Open Access J Urol. 2009;2:1-9. doi:10.2147/rru.s5171

  3. Food and Drug Administration. Fesoterodine prescribing information.

  4. Haab F. Chapter 1: the conditions of neurogenic detrusor overactivity and overactive bladder. Neurourol Urodyn. 2014;33(Suppl 3):S2-S5. doi:10.1002/nau.22636

  5. Wagg AS, Herschorn S, Carlsson M, Fernet M, Oelke M. What are the chances of improvement or cure from overactive bladder? A pooled responder analysis of efficacy and treatment emergent adverse events following treatment with fesoterodine. Neurourol Urodyn. 2021;40(6):1559-1568. doi:10.1002/nau.24706

  6. Fesoterodine. In: Drugs and Lactation Database (LactMed). National Library of Medicine

By Carrie Yuan, PharmD
Carrie Yuan PharmD is a clinical pharmacist with expertise in chronic disease medication management for conditions encountered in primary care.