Trospium
SANCTURA
What it isQuaternary muscarinic antagonist; overactive bladder.
Why this oneIts charge keeps it out of the CNS, so it is the antimuscarinic of choice where cognition matters.
What limits itPeripheral anticholinergic effects remain. Take on an empty stomach; food halves absorption, and it is renally cleared.
FDA-approved for
- overactive bladder (2004)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Overactive bladder | Adults | 60 mg QD (morning) | 60 mg QD | 60 mg/day |
Renal Severe (CrCl <30 mL/min): not recommended. 30–80 mL/min: not studied
Hepatic Use with caution in moderate–severe hepatic impairment; severe not studied
Instructions
- Take with water on an empty stomach, ≥1 h before a meal, once daily in the morning
- Swallow capsule whole
- Do not consume alcohol within 2 h of dosing
Contraindications
- Urinary retention
- Gastric retention
- Uncontrolled narrow-angle glaucoma (or at risk for these conditions)
Cautions
- Risk of urinary retention in bladder outflow obstruction
- Angioedema of face/lips/tongue/larynx — may be life-threatening
- Decreased GI motility/gastric retention risk
- Careful monitoring in narrow-angle glaucoma
- Anticholinergic CNS effects (somnolence, confusion, hallucinations) — caution driving
- Not recommended in severe renal impairment
- Alcohol may enhance drowsiness
Adverse reactions
- Dry mouth
- Constipation
- Dry eye
- Dyspepsia, flatulence, nausea, abdominal pain
- Urinary tract infection
Pregnancy Category C; no adequate human studies; use only if benefit outweighs risk
Lactation Excreted in rat milk (<1%); unknown in human milk; use only if benefit justifies risk
NO BOXED WARNINGS
Principal riskAnticholinergic burden, though poor CNS penetration
Cost, est. cash$5–$150/month
Generic entry2010
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Trospium ballicule
Open Trospium in the interactive console ↗
Memory aids: mascots and interaction avatars
“Red as a beet” crimson color theme → anticholinergic
Approved for overactive bladder
