trospium chloride

trospium chloride

Regurin (UK), Sanctura, Sanctura XR

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

Capsules (extended-release): 60 mg

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, or 1 60-mg capsule daily in morning with water at least 1 hour before a meal

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:

• moderate renal impairment, moderate to severe hepatic impairment, decreased GI motility, controlled angle-closure glaucoma, clinically significant bladder outflow obstruction or GI obstructive disorders

• patients at risk for 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.

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, angioedema

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.

☞ Be aware that angioedema associated with life-threatening upper airway swelling may occur. If involvement of the tongue, hypopharynx, or larynx occurs, promptly discontinue drug and provide appropriate treatment.

Patient teaching

• Instruct patient to take tablet 1 hour before meals on an empty stomach or to take capsule in morning with water at least 1 hour before a meal.

• Instruct patient not to consume alcohol within 2 hours of taking extended-release capsule.

• 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.

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McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved