Home Drug Guide Trospium Chloride

Drug Guide

Generic Name

Trospium Chloride

Brand Names Sanctura, Sanctura XR

Classification

Therapeutic: Urinary Antispasmodic

Pharmacological: Anticholinergic

FDA Approved Indications

Treatment of overactive bladder with symptoms of urinary frequency, urgency, and incontinence

Mechanism of Action

Trospium chloride is an anticholinergic that inhibits muscarinic receptors in the urinary bladder, reducing bladder spasms and increasing bladder capacity.

Dosage and Administration

Adult: Initially, 20 mg twice daily. Dose can be adjusted based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Start at the lower end of the dosing range; monitor for anticholinergic side effects.

Renal Impairment: Reduce dose in patients with impaired renal function; specifics depend on clearance.

Hepatic Impairment: Use with caution; no specific dosage adjustment established.

Pharmacokinetics

Absorption: Orally administered trospium has limited absorption due to P-glycoprotein substrate activity.

Distribution: Limited data; crosses the blood-brain barrier minimally.

Metabolism: Minimal hepatic metabolism.

Excretion: Primarily excreted unchanged in urine; renal clearance is significant.

Half Life: Approximately 20 hours.

Contraindications

Hypersensitivity to trospium chloride or other anticholinergics.
Urinary retention.
Gastric retention.
Unrestricted narrow-angle glaucoma.

Precautions

Use with caution in patients with gastrointestinal obstructive disorders, myasthenia gravis, or urinary retention. Caution in elderly due to anticholinergic side effects.

Adverse Reactions - Common

Dry mouth (Very common)
Constipation (Common)
headache (Common)

Adverse Reactions - Serious

Urinary retention (Uncommon)
Blurry vision (Uncommon)
Angioedema (Rare)

Drug-Drug Interactions

Other anticholinergics (additive effects)
Potassium chloride (oral) reducing absorption
Cimetidine (may increase plasma concentration)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for anticholinergic side effects, urinary retention, and patient’s ability to void.

Diagnoses:

Risk for urinary retention
Impaired urinary elimination
Risk for dry mucous membranes

Implementation: Advise patients to take exactly as prescribed. Monitor urinary function and side effects.

Evaluation: Evaluate reduction in overactive bladder symptoms and tolerability.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of urinary retention or inability to urinate.
Be aware of potential side effects like dry mouth and constipation.
Avoid activities requiring alertness if dizziness occurs.

Special Considerations

Black Box Warnings:

None specified for trospium chloride.

Genetic Factors: No specific genetic considerations identified.

Lab Test Interference: May cause dry mouth, which can affect saliva-based tests.

Overdose Management

Signs/Symptoms: Severe anticholinergic toxicity: xerostomia, blurred vision, urinary retention, hyperthermia, hallucinations, tachycardia.

Treatment: Supportive care; activate charcoal if within 1 hour of ingestion; physostigmine may be considered in severe anticholinergic toxicity under medical supervision.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for the duration of the expiration date.