Trospium
SANCTURA
Pronunciation: TROES-pee-um
“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.
FDA-approved for
- overactive bladder (2004)
FDA label
Read the full label on DailyMed ↗
| 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
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 20 mg | tab | 60 BID | $12.69 | offered |
Available combined with: xanomeline / trospium
Generic entry2010
NO BOXED WARNINGS
Principal riskAnticholinergic burden, though poor CNS penetration
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.
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