Drug Guide
Trospium Chloride; Xanomeline Tartrate
Classification
Therapeutic: Urinary Antispasmodic, Cholinergic Agent
Pharmacological: Muscarinic Receptor Agonist/Antagonist
FDA Approved Indications
- Overactive Bladder (for Trospium Chloride)
Mechanism of Action
Trospium Chloride exerts anticholinergic effects by blocking muscarinic receptors in the bladder, reducing involuntary detrusor muscle contractions. Xanomeline acts as a muscarinic receptor agonist with selectivity for M1/M4 receptors, potentially affecting cognitive functions and possibly used in psychosis or Alzheimer's disease research.
Dosage and Administration
Adult: Trospium Chloride typically 20 mg twice daily. Xanomeline's dosing is investigational and under clinical trials.
Pediatric: Not approved for pediatric use.
Geriatric: Adjust doses as needed; monitor for anticholinergic side effects.
Renal Impairment: Use with caution; dose adjustments may be necessary.
Hepatic Impairment: Data limited; use caution and monitor for side effects.
Pharmacokinetics
Absorption: Trospium has poor oral bioavailability (~10%).
Distribution: Widely distributed; crosses the blood-brain barrier poorly.
Metabolism: Minimal hepatic metabolism.
Excretion: Primarily via kidneys; unchanged.
Half Life: Approx. 20 hours for Trospium.
Contraindications
- Hypersensitivity to Trospium or Xanomeline.
- Urinary retention.
- Uncontrolled glaucoma.
Precautions
- Use with caution in patients with myasthenia gravis, gastric retention, or known obturator nerve compression. Monitor for anticholinergic side effects: dry mouth, constipation, blurred vision, urinary retention. Xanomeline should be used under research settings with supervision.
Adverse Reactions - Common
- Dry mouth (Frequent)
- Constipation (Frequent)
- Dizziness (Less common)
Adverse Reactions - Serious
- Urinary retention (Rare)
- Myasthenic crisis (Rare)
- Gastrointestinal obstruction (Rare)
Drug-Drug Interactions
- Other anticholinergic drugs, which may increase anticholinergic side effects.
Drug-Food Interactions
- Alcohol may enhance sedative effects.
Drug-Herb Interactions
- Potential interactions with herbs affecting the central nervous system or anticholinergic pathways.
Nursing Implications
Assessment: Monitor urinary retention, bowel function, and signs of anticholinergic toxicity.
Diagnoses:
- Risk for urinary retention.
- Risk for constipation.
- Risk for dry mouth.
Implementation: Administer as prescribed, educate patient on managing side effects, monitor for adverse reactions.
Evaluation: Assess symptom control and side effect profile regularly.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any difficulty urinating, constipation, or severe dry mouth.
- Avoid driving if experiencing dizziness or blurred vision.
- Maintain hydration and fiber intake to prevent constipation.
Special Considerations
Black Box Warnings:
- None specific for Trospium; caution in patients with urinary retention or myasthenia gravis. Xanomeline's black box warnings are related to its investigational status and potential cognitive effects.
Genetic Factors: Genetic variations in muscarinic receptors may influence response (research area).
Lab Test Interference: None reported.
Overdose Management
Signs/Symptoms: Severe anticholinergic symptoms: hallucinations, seizures, hyperthermia, urinary retention.
Treatment: Supportive care, activated charcoal if recent ingestion, and physostigmine in severe anticholinergic toxicity under medical supervision.
Storage and Handling
Storage: Store at room temperature away from moisture and light.
Stability: Stable under recommended storage conditions.