trospium chloride

trospium chloride

Regurin (UK), Sanctura

Pharmacologic class: Anticholinergic, antimuscarinic

Therapeutic class: Renal and genitourinary agent, antispasmodic

Pregnancy risk category C

Action

Antagonizes effects of acetylcholine on muscarinic receptors in cholinergically innervated organs, reducing bladder smooth muscle tone

Availability

Tablets: 20 mg

⊘Indications and dosages

➣ Overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency

Adults: 20 mg P.O. twice daily 1 hour before meals or on empty stomach

Dosage adjustment

• Severe renal impairment
• Patients age 75 and older

Contraindications

• Hypersensitivity to drug or its components
• Preexisting or risk of urinary or gastric retention or uncontrolled angle-closure glaucoma

Precautions

Use cautiously in:
• renal insufficiency, hepatic impairment, decreased GI motility, controlled angle-closure glaucoma
• risk of urinary retention or heat prostration
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give at least 1 hour before meals or on empty stomach.

Route	Onset	Peak	Duration
P.O.	Unknown	5-6 hr	Unknown

Adverse reactions

CNS: headache, fatigue, syncope, hallucinations, delirium, dizziness, drowsiness

CV: tachycardia, chest pain

EENT: dry eyes, blurred vision, dry throat

GI: vomiting, constipation (new-onset or aggravated), upper abdominal pain, dyspepsia, flatulence, abdominal distention, dry mouth

GU: urinary retention

Skin: dry skin

Other: altered taste, heat prostration

Interactions

Drug-drug. Anticholinergics: additive anticholinergic effects

Digoxin, metformin, morphine, pancuronium, procainamide, tenofovir, vancomycin: increased blood levels of both drugs

Drug-behaviors. Alcohol use: increased risk of drowsiness

Patient monitoring

• Monitor renal and hepatic function tests.
• Monitor patient for decreased GI motility and urinary retention.
☞ If patient has controlled angle-closure glaucoma, stay alert for severe eye pain accompanied by nausea, rainbows around lights, red eye, and blurred vision. Be prepared to treat immediately, as appropriate.

Patient teaching

• Instruct patient to take drug 1 hour before meals or on empty stomach.
• Advise patient to consult prescriber before taking over-the-counter products such as antihistamines because these may increase risk of side effects.
• Inform patient that drug increases risk of heat prostration; describe symptoms and advise him to seek prompt medical attention if these occur.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• Advise patient to avoid alcohol use.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.