BRAND NAMES
- Canada: Trosec PI
- Egypt: Spasmex
- Germany: Spasmex, Spasmolyt
- India: Tropez OD
- Israel: Spasmex PI
- Italy: Urivesc PI
- Lebanon: Spasmex
- UK: Flotros, Regurin
- U.S.: Sanctura PI
 MECHANISM OF ACTION
Trospium chloride, a quaternary ammonium derivative acts as a muscarinic antagonist. It antagonizes the effect of acetylcholine on muscarinic receptors in cholinergically innervated organs including the bladder. Trospium chloride has a high affinity to the M1 and M3-receptors and has in relation to these a some lower affinity to the M2-receptor. Its parasympatholytic action reduces the tonus of the smooth muscles in the gastrointestinal and urogenital tract. It inhibits the bronchial, salivary and sweat secretion and paralyses accommodation.
- Treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency
- 20 mg tablets: The recommended dose is one 20 mg tablet twice daily on an empty stomach, at least one hour before a meal.
- 30 mg tablets: The recommended dose is one 15 mg (1/2 tablet) three times a day, or one 30mg tablet in the morning and 15 mg (half a tablet) in the evening on an empty stomach, at least one hour before a meal.
- Urinary retention
- Gastric retention
- Myasthenia gravis
- Uncontrolled narrowangle glaucoma
- Known hypersensitivity to Trospium chloride
 WARNINGS AND PRECAUTIONS
- Gastrointestinal: Trospium chloride should be administered with caution to patients with gastrointestinal obstructive disorders due to risk of gastric retention. Trospium chloride also may decrease gastrointestinal motility and should be used with caution in patients with conditions such as ulcerative colitis, intestinal atony.
- Renal: Trospium chloride should be administered with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention.
- Immune: Angioedema of the face, lips, tongue and/or larynx has been reported with trospium chloride.
- Glaucoma: In patients with controlled narrow angle glaucoma Trospium chloride should be used only if the potential benefits outweigh the risks and with careful monitoring.
- Central Nervous System Effects: Somnolence has been reported, patients should be advised not to drive or operate heavy machinery until they know how Trospium chloride affects them.
- Renal impairment: The risk of anticholinergic adverse reactions of Trospium chloride is expected to be greater in patients with moderate renal impairment.
- Alcohol may enhance the drowsiness
- The anticholinergic effect of amantadine, tricyclic antidepressants, quinidine, antihistamines and disopyramide may be increased.
- The tachycardic effect of Beta-agonists may be increased.
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). There are no adequate and well-controlled studies of Trospium chloride in pregnant women. It should be used during pregnancy only if the potential benefit to the patient outweighs the risk to the patient and fetus.
- Nursing Mothers: Trospium chloride was excreted, to a limited extent (less than 1%), into the milk of lactating rats (primarily as parent compound). It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, Trospium chloride should be used during lactation only if the potential benefit justifies the potential risk to the newborn.
 SIDE EFFECTS
The most common adverse reactions (greater than or equal to 1%) are dry mouth (20.1%), constipation (9.6%), and headache (4.2%)
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