Trospium

SANCTURA

Open Trospium in the interactive console ↗

Pronunciation: TROES-pee-um

Trospium ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Trospium ballicule

Trospium SANCTURA mascot mnemonic cartoon — Visual mnemonic: Trospium mascot
**“Trusty pee-in Sanctuary”**
“Red as a beet” crimson color theme → anticholinergic
Approved for overactive bladder

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.

Trospium molecular structure (skeletal formula) — Molecular structure: Trospium

Trospium prescription history

Animated chart of estimated U.S. prescriptions per year, Overactive bladder meds (1970–2026). Trospium enters in 2004 (estimated).

FDA-approved for

overactive bladder (2004)

Principal riskAnticholinergic burden, though poor CNS penetration

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism4 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Overactive bladder (urge incontinence, urgency, frequency)	Adults	20 mg BID	20 mg BID	20 mg BID

Renal Severe renal impairment (CrCl <30 mL/min): 20 mg once daily at bedtime.

Hepatic Undefined (not studied).

Instructions

Take with water on an empty stomach, at least 1 hour before meals
Patients ≥75 yr: may titrate down to 20 mg once daily based on tolerability

Available strengths

tab 20 mg
ER cap 60 mg

Contraindications

Urinary retention
Gastric retention
Uncontrolled narrow-angle glaucoma

Cautions

Urinary/gastric retention risk
Angioedema
Controlled narrow-angle glaucoma
CNS effects (somnolence)
Greater anticholinergic effects in moderate renal impairment

Adverse reactions

Dry mouth
Constipation
Headache

Pregnancy Undefined.

Lactation Undefined.

Cost

Trospium (SANCTURA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
20 mg	tab	60 BID	$12.69	offered

Available combined with: xanomeline / trospium

Generic entry2010

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Memory aids: interaction avatars

Box: minimal PK interactions

Open Trospium in the interactive console ↗

Self-check

Why does trospium have little CNS entry?
Its charge.
What does food do to trospium absorption?
Halves it.