trospium

Therapeutic Classification: urinary tract antispasmodics

Pharmacologic Classification: antimuscarinics

Indications ⬆ ⬇

REMS

Overactive bladder with symptoms of urge urinary incontinence, urgency and urinary frequency.

Action ⬆ ⬇

Antagonizes the effect of acetylcholine at muscarinic receptors in the bladder; this parasympatholytic action reduces bladder smooth muscle tone.

Therapeutic effects:

Increased bladder capacity and decreased symptoms of overactive bladder.

Pharmacokinetics ⬆ ⬇

Absorption: Less than 10% absorbed following oral administration; food significantly ↓ absorption.

Distribution: Mostly distributed to plasma.

Metabolism/Excretion: Of the 10% absorbed, 40% is metabolized. Unabsorbed drug is mainly excreted in feces. Of absorbed drug, 60% is eliminated in urine as unchanged drug via active tubular secretion.

Half-Life: 20 hr.

Time/Action Profile ⬆ ⬇

(anticholinergic effects)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	5–6 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Gastric or urinary retention, uncontrolled angle-closure glaucoma or risk for these conditions.

Use Cautiously in:

Bladder outflow obstruction;
Gastrointestinal obstructive disorders (ulcerative colitis, intestinal atony, myasthenia gravis);
Controlled angle-closure glaucoma (use only if necessary and with careful monitoring);
CCr <30 mL/min (dose ↓ recommended);
Moderate to severe hepatic impairment;
OB: Use only if benefit justifies risks to fetus/newborn;
Pedi: Safety not established;
Geri: May have↑ sensitivity to anticholinergic effects; ↓ dose may be required.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: blurred vision

GI: constipation, dry mouth, dyspepsia

GU: urinary retention, urinary tract infection

Neuro: headache, confusion, dizziness, drowsiness, fatigue, hallucinations

Misc: ANGIOEDEMA, fever, heat stroke

Interactions ⬆ ⬇

Drug-drug:

May interact with other drugs that compete for tubular secretion.
Metformin may ↓ levels.
↑risk of anticholinergic effects with other drugs having anticholinergic properties.

Route/Dosage ⬆ ⬇

PO (Adults ): 20 mg twice daily or 60 mg once daily (XR dose form).
PO (Adults ≥75 yr): Based on tolerability, dose may be ↓ to 20 mg once daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: 20 mg once daily at bedtime.

Availability ⬆ ⬇

(Generic available)

Tablets: 20 mg
Extended release tablets: 60 mg

Assessment ⬆ ⬇

Monitor voiding pattern and intake and output ratios.

Implementation ⬆ ⬇

PO: Administer 1 hr prior to meals or on an empty stomach.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take as directed. If a dose is skipped, take next dose 1 hr prior to next meal.
May cause drowsiness, dizziness, and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to medication is known. Advise patient to avoid alcohol; may increase drowsiness.
Advise patient to notify health care professional immediately of signs and symptoms of angioedema (edema of the tongue or laryngopharynx, difficulty breathing) occur.
Caution patient that heat prostration (fever and heat stroke due to decreased sweating) may occur when trospium is taken in a hot environment.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.

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Pronunciation ⬇

Classifications ⬆ ⬇