Tolterodine and its major active 5-hydroxymethyl metabolite (5-HM) are potent muscarinic receptor antagonists that show selectivity for the urinary bladder over salivary glands in vivo. This tissue selectivity cannot be attributed to muscarinic receptor subtype selectivity, since both compounds are non-selective with respect to the M 1 -M 5 receptor subtypes. The aim of the present in vitro study was to determine the specificity of tolterodine and 5-HM for muscarinic receptors compared to other potential cellular targets. Carbachol-induced contractions of isolated guinea pig bladder were effectively inhibited by tolterodine (IC 50 14 nM) and 5-HM (IC 50 5.7 nM). Tolterodine and 5-HM were weak inhibitors of effects mediated by a-adrenergic receptors (rat portal vein), histamine receptors (guinea pig ileum) and calcium channels (guinea pig potassium-depolarised urinary bladder, spontaneously beating right atria and electrically-driven right papillary muscle). The IC 50 values were in the mM range and the antimuscarinic potency of tolterodine was 27, 200 and 370-485 times higher, respectively, than its potency in blocking histamine receptors, a-adrenoceptors and calcium channels. The active metabolite, 5-HM, was ÏŸ900 times less potent at these sites than at bladder muscarinic receptors. Radioligand binding data on 54 different receptors and binding sites showed that tolterodine and 5-HM bind with significant affinity only at muscarinic receptors. In conclusion, the results of the present study indicate that both tolterodine and 5-HM are specific muscarinic receptor antagonists. The tissue selectivity of these agents in vivo cannot therefore be explained by secondary pharmacological actions.Overactive (unstable) bladder is characterised by uncontrolled contractions of the detrusor muscle during the filling phase of the micturition cycle, resulting in symptoms of increased micturition frequency and urgency, with or without urge incontinence. Contractions of the human detrusor are considered to be predominantly mediated by cholinergic muscarinic receptors (Andersson 1993). Antimuscarinic drugs are therefore widely used in the treatment of bladder overactivity, but the clinical utility of older drugs (e.g. oxybutynin) is limited by their classical antimuscarinic side-effects, e.g. bothersome dry mouth (Andersson et al. 1999). Indeed, antimuscarinic side-effects often result in discontinuation of drug treatment (Yarker et al. 1995;Kelleher et al. 1997).Tolterodine ( fig. 1) is the first muscarinic receptor antagonist to be specifically developed for the treatment of overactive bladder. Data from studies in healthy volunteers show that the effect of tolterodine on the bladder is rapid in onset and long lasting, whereas the effect on salivation is transient and only apparent around the time of peak serum levels (Stahl et al. 1995;Brynne et al. 1997). Moreover, results from comparative clinical studies in patients with overactive bladder show that tolterodine (2 mg twice daily) is as effective as oxybutynin (5 mg...