Darifenacin, Fesoterodine, Flavoxate, Oxybutynin, Propiverine, Solifenacin, Tolterodine, Trospium
Issues for Surgery |
Risk of increased urinary frequency, urgency and urge incontinence if omitted. Solifenacin and tolterodine – risk of QT-interval prolongation if continued (see Interaction(s) with Common Anaesthetic Agents and Interaction(s) with other Common Medicines used in the Perioperative Period) Combination product containing tamsulosin – risk of hypotension if continued (see Alpha-adrenoceptor Blockers monograph). Combination product containing tamsulosin – risk of Intraoperative Floppy Iris Syndrome (IFIS) if continued prior to cataract surgery (see Alpha-adrenoceptor Blockers monograph). |
Advice in the Perioperative period |
Elective and Emergency Surgery
Patients undergoing Cataract Surgery Post-operative Advice Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Review appropriateness of continuing treatment if patient develops post-operative delirium2. Patients undergoing Overactive Bladder Surgery |
Interaction(s) with Common Anaesthetic Agents |
Antimuscarinic action Hypotension QT-Interval Prolongation Tolterodine prolongs the QT-interval and post-marketing reports indicate solifenacin may also prolong the QT-interval11. Co-administration with other medicines known to prolong the QT-interval must be based on careful assessment of the potential risks and benefits for each patient. Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include2, 11: -
*monitor ECG if concurrent use unavoidable; if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) use greater caution **monitor ECG with concurrent use if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia). Whilst QT-interval prolongation has not been observed in patients taking fesoterodine the manufacturers advise caution with concomitant administration of medicines known to prolong the QT-interval4. |
Interaction(s) with other Common Medicines used in the Perioperative Period |
Prokinetics Antimuscarinic action Nefopam Antimicrobials (for solifenacin and tolterodine also see QT-interval prolongation below) Hypokalaemia QT-Interval Prolongation Medicines that may be used in the perioperative period that are known to prolong the QT-interval include11:-
*monitor ECG with concurrent use if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) |
Further Information |
Intraoperative Floppy Iris Syndrome (IFIS) |
References |
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