propiverine

Exhibits anticholinergic and calcium-modulating properties. The efferent connection of the pelvic nerve is inhibited due to anticholinergic action, resulting in relaxation of bladder smooth muscle. Inhibits the calcium influx and modulates the intracellular calcium in urinary bladder smooth muscle cells, causing musculotropic spasmolysis.

Therapeutic effects:

Reduced urinary incontinence, frequency, and urgency.

Pharmacokinetics ⬆ ⬇

Absorption: 50–60% absorbed following oral administration (↑ with high-fat meal).

Distribution: Extensively distributed to tissues.

Protein Binding: 90–95%.

Metabolism/Excretion: Primarily metabolized by the liver; 60% excreted in urine (<1% as unchanged drug); 21% excreted in feces.

Half-Life: 14–20 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	30 min–1 hr	2–10 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Bladder outflow obstruction with urinary retention;Bowel obstruction;
Fructose intolerance or sucrase-isomaltase insufficiency;
Galactose intolerance/Lapp lactase deficiency/glucose-galactose malabsorption;
Intestinal atony;
Myasthenia gravis;
Severe ulcerative colitis;
Toxic megacolon;
Uncontrolled angle-closure glaucoma;
Moderate or severe hepatic impairment.

Use Cautiously in:

Autonomic neuropathy;
Arrhythmia;
Hiatus hernia with reflux esophagitis;
Prostatic enlargement;
Class IV HF;
Tachycardia;
Renal impairment;
Mild hepatic impairment;
OB: Safety and effectiveness not established in pregnancy;
Lactation: Safety and effectiveness not established in breastfeeding;
Pedi: Children <5 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, palpitations, tachycardia

Derm: pruritus, rash

EENT: dry mouth

GI: abdominal pain, constipation, dyspepsia

GU: bladder and urethral symptoms, urinary retention

Neuro: blurred vision, confusion, dizziness, fatigue, headache, restlessness, sedation, tremor

Interactions ⬆ ⬇

Drug-drug:

Tricyclic antidepressants, benzodiazepines, and anticholinergics may ↑ risk of toxicity.
May ↑ effects of amantadine, phenothiazines, and beta agonists.
Cholinergics may ↓ effectiveness.
Isoniazid may ↑ risk of hypotension.
May ↓ effectiveness of metoclopramide.

Route/Dosage ⬆ ⬇

PO (Adults ): Extended-release capsules:30 mg once daily; may ↑ to a max of 45 mg once daily.
PO (Children ≥35 kg): 15 mg twice daily (max = 30 mg/day).
PO (Children <35 kg ): Immediate-release tablets: 0.8 mg/kg/day in 2 divided doses; alternatively, the following body weight adjusted dosing may be used. 29–34 kg: 10 mg in morning and 15 mg in evening. 23–28 kg: 10 mg 2 times daily. 17–22 kg: 5 mg in morning and 10 mg in evening. 12–16 kg: 5 mg twice daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: Max dose =30 mg/day.

Availability ⬆ ⬇

Immediate-release tablets: 5 mg
Extended-release capsules: 30 mg; 45 mg

Assessment ⬆ ⬇

Before starting therapy, rule out alternative causes of pollakiuria and nocturia (organic bladder disease such as UTI or malignancy, HF).
Assess urinary frequency, urgency, incontinence, and bladder spasms before and periodically during therapy.
Monitor for urinary retention. Measure postvoid residual if needed.
Monitor for ECG changes (tachycardia, arrhythmias, and prolonged QT interval) during therapy.

Lab Test Considerations:

Monitor hepatic function. If liver enzymes and/or bilirubin ↑ above normal values, discontinue propiverine.

Implementation ⬆ ⬇

PO: Administer with or without food. DNC: Swallow extended-release capsules whole. Do not crush, break, or chew.
Immediate-release tablets should be taken ≥1 hr before meals.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Advise patient it may take several days to notice improvement in symptoms. Advise if dose is missed, the next dose should be taken as planned. Do not double dose. The prescribed dosing schedule should be continued.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient to notify health care provider if signs and symptoms of glaucoma (blurred vision, eye pain, headache, side vision loss) and worsening neuropathy occur.
Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to perform good oral hygiene and sugarless gum or candy for dry mouth.
Advise patient about adequate fluid intake and fiber-rich diet to prevent constipation.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇