From the Guidelines
Trospium is an antimuscarinic medication used to treat overactive bladder symptoms, with a recommended dose of 20 mg twice daily, and is associated with common side effects such as dry mouth, constipation, and blurred vision, as reported in studies 1.
Key Characteristics of Trospium
- Belongs to a class of drugs called anticholinergics or muscarinic antagonists
- Works by blocking certain nerve signals to the bladder muscles, reducing bladder contractions and improving control over urination
- Typically prescribed as trospium chloride in doses of 20 mg twice daily or as an extended-release formulation of 60 mg once daily
- Common side effects include dry mouth, constipation, and blurred vision
Important Considerations for Trospium Use
- Does not cross the blood-brain barrier as readily, potentially causing fewer cognitive side effects, making it a good option for elderly patients
- People with certain conditions like glaucoma, urinary retention, or severe gastrointestinal disorders should avoid using trospium
- The medication should be taken on an empty stomach, at least one hour before meals, to maximize absorption and effectiveness
Comparison with Other Medications
- Studies have compared the efficacy and safety of trospium with other antimuscarinics, such as tolterodine and solifenacin, as well as with mirabegron, a beta(3)-adrenoceptor agonist, as reported in 1
- 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
From the FDA Drug Label
Trospium chloride is an antispasmodic, antimuscarinic agent. Trospium chloride antagonizes the effect of acetylcholine on muscarinic receptors in cholinergically innervated organs including the bladder. 12.1 Mechanism of Action Trospium chloride is an antispasmodic, antimuscarinic agent.
Trospium is an antimuscarinic medication. It works by antagonizing the effect of acetylcholine on muscarinic receptors in the bladder, reducing the tonus of smooth muscle in the bladder. 2 2 2
From the Research
Definition and Mechanism of Action
- Trospium chloride is an antimuscarinic agent with predominantly peripheral nonselective antimuscarinic activity, lacking central nervous system effects 3.
- It binds specifically and with high affinity to muscarinic receptors M(1), M(2), and M(3), but not nicotinic, cholinergic receptors 4.
- Trospium chloride is hydrophilic and does not cross the normal blood-brain barrier in significant amounts, resulting in minimal central anticholinergic activity 4.
Therapeutic Use
- Trospium chloride is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency 5.
- It is effective in decreasing the number of voids, urge incontinent episodes, total daily micturitions, and urge severity, and in increasing volume per void 3.
- Trospium chloride has been shown to improve symptoms of overactive bladder and quality of life 3, 4.
Pharmacokinetics and Pharmacodynamics
- Peak plasma trospium chloride concentrations are attained approximately 5-6 hours after oral administration, which should occur before meals as concurrent food ingestion significantly reduces trospium bioavailability 4.
- Trospium chloride undergoes negligible metabolism by the hepatic cytochrome P450 system, resulting in few metabolic drug interactions 4.
- The most frequent adverse events associated with trospium chloride are dry mouth, dyspepsia, constipation, abdominal pain, and nausea 4, 6.
Efficacy and Tolerability
- Trospium chloride has been shown to be effective and well-tolerated for the treatment of overactive bladder syndrome in several clinical trials 3, 6.
- It has been compared to other antimuscarinic agents, such as oxybutynin and tolterodine, and has been found to be at least as effective 4.
- Trospium chloride has a favorable safety profile, with low rates of central nervous system adverse events 6.