Trospium

What is Trospium

Trospium is a non-specific antimuscarinic agent used orally in the treatment of overactive bladder.

Trospium decreases the frequency of bladder contractions, resulting in a reduction in urinary frequency, urgency and incontinence.

Trospium is effective in patients with idiopathic or neurogenic detrusor overactivity, with symptoms of overactive bladder improving as early as one week following drug initiation.

In addition, the safety and efficacy of trospium for the treatment of overactive bladder has been demonstrated for up to 52 weeks.

While not FDA-approved, limited data indicate that trospium may be effective in treating overactive bladder in pediatric patients.

The most commonly reported adverse effects of trospium are dry mouth and constipation, both of which are expected effects of antimuscarinic drugs. Trospium has been shown to be as effective as oxybutynin, but with better tolerability in clinical trials (e.g., less xerostomia).

Trospium is a quaternary amine and does not cross the blood-brain barrier or conjunctiva like oxybutynin, a tertiary amine.

Therefore, CNS related side effects such as dizziness, drowsiness, nervousness, and EEG changes are expected to be less common with trospium (see Adverse Reactions).

The incidence of xerophthalmia is low. In contrast to tolterodine, trospium is not a substrate or inhibitor of cytochrome P-450 enzymes; interactions involving drug metabolism are not expected with trospium. Preliminary data indicate that trospium may be effective when instilled intravesically.

Unlike intravesical oxybutynin, trospium has the potential advantage for minimal systemic absorption.

However, more clinical data is needed before this route of administration can be routinely recommended.

Trospium has been available in Europe for greater than 20 years.

Trospium (Sanctura®) was US FDA approved in May 2004; an extended-release capsule (Sanctura® XR) was approved in August 2007.

Brand Name

Sanctura | Sanctura XR

Indications

  • enuresis
  • neurogenic bladder
  • overactive bladder (OAB)
  • urinary incontinence

For the treatment of overactive bladder (OAB) with symptoms of urgency, frequency, and urge urinary incontinence (includes neurogenic bladder)

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. angioedema
  4. blurred vision
  5. chest pain (unspecified)
  6. confusion
  7. constipation
  8. cystitis
  9. delirium
  10. dizziness
  11. drowsiness
  12. dysgeusia
  13. dyspepsia
  14. fatigue
  15. flatulence
  16. gastritis
  17. hallucinations
  18. headache
  19. hypertension
  20. hypertensive crisis
  21. nausea
  22. palpitations
  23. rash
  24. rhabdomyolysis
  25. sinus tachycardia
  26. ST-T wave changes
  27. Stevens-Johnson syndrome
  28. supraventricular tachycardia (SVT)
  29. syncope
  30. urinary retention
  31. visual impairment
  32. vomiting
  33. xerophthalmia
  34. xerosis
  35. xerostomia

Monitoring Parameters

  • serum creatinine

Contraindications

  • anticholinergic medications
  • autonomic neuropathy
  • breast-feeding
  • children
  • closed-angle glaucoma
  • contact lenses
  • driving or operating machinery
  • ethanol ingestion
  • gastroesophageal reflux disease (GERD)
  • gastroparesis
  • geriatric
  • GI obstruction
  • hepatic disease
  • ileus
  • myasthenia gravis
  • pregnancy
  • prostatic hypertrophy
  • pyloric stenosis
  • renal disease
  • renal failure
  • renal impairment
  • toxic megacolon
  • ulcerative colitis
  • urinary retention
  • urinary tract obstruction

Interactions

  • Abacavir; Dolutegravir; Lamivudine
  • Abacavir; Lamivudine, 3TC
  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Acrivastine; Pseudoephedrine
  • Adefovir
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Alogliptin; Metformin
  • Alosetron
  • Amantadine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amoxapine
  • Antacids
  • Anticholinergics
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Atenolol; Chlorthalidone
  • Azilsartan; Chlorthalidone
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Botulinum Toxins
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bumetanide
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Butorphanol
  • Caffeine
  • Canagliflozin; Metformin
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexbrompheniramine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlorcyclizine
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Cholinergic agonists
  • Cimetidine
  • Cisapride
  • Clemastine
  • Clozapine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Cyclizine
  • Cyclobenzaprine
  • Cyproheptadine
  • Dapagliflozin; Metformin
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Digoxin
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Dofetilide
  • Dolutegravir; Lamivudine
  • Donepezil
  • Donepezil; Memantine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Entecavir
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Ertugliflozin; Metformin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Ethacrynic Acid
  • Ethanol
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • food
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Furosemide
  • Galantamine
  • Glipizide; Metformin
  • Glyburide; Metformin
  • Glycopyrronium
  • Green Tea
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydroxyzine
  • Itraconazole
  • Ketoconazole
  • Lamivudine, 3TC
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Levocetirizine
  • Linagliptin; Metformin
  • Loop diuretics
  • Lurasidone
  • Maprotiline
  • Meclizine
  • Megestrol
  • Memantine
  • Meperidine; Promethazine
  • Mesoridazine
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methyclothiazide
  • Metolazone
  • Midodrine
  • Mirtazapine
  • Nabilone
  • Nalbuphine
  • Olanzapine
  • Omeprazole; Sodium Bicarbonate
  • Opiate Agonists
  • Orphenadrine
  • Pancuronium
  • Pentazocine
  • Pentazocine; Naloxone
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenothiazines
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Proton pump inhibitors
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranitidine
  • Rasagiline
  • Rivastigmine
  • Secretin
  • Sedating H1-blockers
  • Sodium Bicarbonate
  • Solifenacin
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Tacrine
  • Tapentadol
  • Tegaserod
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiazide diuretics
  • Thiethylperazine
  • Thioridazine
  • Thiothixene
  • Topiramate
  • Torsemide
  • Tramadol
  • Triamterene
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimethobenzamide
  • Trimethoprim
  • Triprolidine
  • Vancomycin
  • Zonisamide
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