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Trospium

Class
Smooth muscle relaxants
Subclass
Muscarinic receptor antagonists
Substance name
Trospium
Common formulations
Film-coated tablet
See also
Trospium ER
Contained in
Xanomeline / trospium (Cobenfy®)
Dosage and administration
Adults patients
Treatment of overactive bladder
•
20 mg PO BID
Taken at least 1 hour before meals or empty stomach. Consider down-titrating to 20 mg daily in elderly patients based on tolerability.
Indications for use
Labeled indications
Adults
•
Treatment of overactive bladder
Safety risks
Contraindications
Hypersensitivity to trospium chloride or its components
Gastric retention
Uncontrolled narrow-angle glaucoma
•
Use caution in patients with anatomically narrow angles.
Urinary retention
Warnings and precautions
Angioedema
•
Maintain a high level of suspicion, as trospium chloride has been associated with an increased risk of angioedema.
Anticholinergic syndrome
•
Use caution in patients taking other antimuscarinic drugs.
CNS adverse events
•
Use caution, as trospium chloride is associated with anticholinergic CNS effects, including dizziness, confusion, hallucinations, and somnolence. Advise patients to avoid alcohol consumption, as it may exacerbate drowsiness. Also, instruct patients to avoid driving or operating heavy machinery until they know how trospium chloride affects their alertness. Consider reducing the dose or discontinuing trospium chloride if anticholinergic CNS effects occur.
Decreased gastrointestinal motility
•
Use caution in patients with gastrointestinal obstructive disorders, ulcerative colitis, intestinal atony or myasthenia gravis.
Increased serum trospium levels
•
Use caution in patients taking drugs that are eliminated by active tubular secretion. Monitor for adverse drug reactions.
Urinary retention
•
Use caution in patients with clinically significant bladder outflow obstruction.
Specific populations
Renal impairment
CrCl ≥ 30 mL/min
•
Use acceptable. No dose adjustment required. Monitor for adverse reactions.
CrCl < 30 mL/min
•
Maximal dose of 20 mg qHs.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use with caution. No dose adjustment required.
Child-Pugh C (severe)
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Dry mouth
Common 1-10%
•
Abdominal pain, constipation, dry eyes, fatigue, flatulence, dyspepsia, headache, nausea, urinary retention, tachycardia, blurred vision, abdominal distension, vomiting, dysgeusia, skin dryness, throat dryness, urinary tract infections, xeroderma pigmentosum
Unknown frequency
•
Gastritis, supraventricular tachycardia, hypertensive crisis, anaphylaxis, Stevens-Johnson syndrome, back pain, drowsiness, heat intolerance, palpitations, chest pain, syncope, angioedema, dizziness, confusion, visual disturbances, delirium, hallucinations, rhabdomyolysis
Interactions
Drug(s)
Check Interactions
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