Mechanism of action: Xanomeline balliculeVisual mnemonic: Xanomeline mascot “The gnome line” Light blue → cholinergic / muscarinic Hypersalivation if not paired with trospium Urinary urgency/frequency if not combined with trospium
What it isM1 and M4 muscarinic agonist, given with trospium; schizophrenia.
Why this oneThe first antipsychotic in decades that does not block D2, so there is no extrapyramidal or prolactin effect.
What limits itPeripheral cholinergic effects — nausea, vomiting, sweating — are why trospium is co-formulated.
Molecular structure: Xanomeline
FDA-approved for
schizophrenia (with trospium) (2024)
NO BOXED WARNINGS
Principal riskPeripheral cholinergic effects — nausea, vomiting, sweating — which is exactly why trospium is c