What is Trospium (Trospium chloride)?

From the Guidelines

Trospium is a recommended treatment for overactive bladder symptoms, including urinary frequency, urgency, and incontinence, and should be considered as a second-line therapy, as stated in the AUA/SUFU guideline 1.

Key Points

• The standard dosage of trospium is 20 mg twice daily, taken on an empty stomach at least one hour before meals, or an extended-release formulation of 60 mg once daily in the morning.
• Trospium works by blocking muscarinic receptors in the bladder, which reduces involuntary bladder contractions and increases bladder capacity.
• Unlike some other anticholinergics, trospium has limited ability to cross the blood-brain barrier, potentially resulting in fewer central nervous system side effects.
• Common side effects include dry mouth, constipation, and blurred vision.
• Trospium should be used cautiously in elderly patients and those with narrow-angle glaucoma, gastrointestinal obstructive disorders, or significant bladder outflow obstruction.
• Patients should maintain adequate hydration while taking this medication and may need to adjust the dosage if they have severe renal impairment.
• Improvement in bladder symptoms typically begins within 1-2 weeks of starting treatment.

Considerations

• The choice of pharmacologic agent should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as recommended by the American College of Physicians 1.
• Adverse effects are a major reason for treatment discontinuation, and clinicians and their patients should compare the risk for pharmacologic adverse effects with the severity and bothersomeness of the patient’s symptoms 1.
• Moderate-quality evidence indicates that trospium reduces the number of urgency UI episodes, regardless of whether the patient is receiving other drugs 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Trospium

• Trospium chloride is an antimuscarinic agent indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency 2.
• It has unique chemical and pharmacokinetic properties, including minimal central nervous system penetration, no metabolism by the cytochrome P450 system, and excretion mainly unchanged in the urine as the active parent compound 2.

Efficacy of Trospium

• Trospium 20 mg twice daily was more effective than placebo in reducing the number of micturitions per 24 hours, reducing the number of urge incontinence episodes per week, and increasing the volume of urine voided per micturition in two 12-week, randomized, placebo-controlled clinical studies in adults with OAB 2.
• Once daily trospium chloride 60 mg was effective and well tolerated for the treatment of OAB, with significant improvements in daily urinary frequency and daily urgency urinary incontinence episodes 3, 4.
• Trospium chloride once-daily extended release 60 mg resulted in statistically significant improvements in both primary and secondary outcome variables, with favorable rates of adverse events, particularly central nervous system adverse events 4.

Onset of Improvement

• There were statistically significant improvements in efficacy over placebo in endpoints within a few days of treatment, with improvements in symptoms continuing to 7 days of treatment 5.
• Clinically meaningful improvements in most endpoints were observed by the end of the first week of treatment with trospium chloride 20 mg twice daily 5.

Comparison with Other Treatments

• Trospium appears to be a feasible alternative for patients who cannot tolerate oxybutynin, with a lower tendency for drug interactions and minimal central nervous system penetration 2.
• Mirabegron, a β3 adrenoceptor agonist, has been shown to be effective in reducing OAB symptoms, with a lower incidence of dry mouth compared to antimuscarinic agents 6.