TROSPIUM CHLORIDE

TROSPIUM CHLORIDE
(tro-spi'um)
Sanctura, Sanctura XR
Classifications: anticholinergic; antimuscarinic; antispasmodic;
Therapeutic:anticholinergic; antispasmodic; urinary smooth muscle relaxant
Prototype: Ipratropium bromide
Pregnancy Category: C

Availability

20 mg tablets; 60 mg extended release capsule

Action

Antagonizes the effect of acetylcholine on muscarinic receptors in smooth muscle. Its parasympatholytic action reduces the tonus of the smooth muscle of the bladder.

Therapeutic Effect

Trospium decreases urinary frequency, urgency, and urge incontinence in patients with overactive bladders.

Uses

Treatment of overactive (neurogenic) bladder with symptoms of urgency, frequency, and urge urinary incontinence.

Contraindications

Hypersensitivity to trospium; patients with or at risk for urinary retention; uncontrolled narrow-angle glaucoma; gastric tension, GI obstruction, ileus, pyloric stenosis, toxic megacolon, severe ulcerative colitis; pregnancy (category C). Safety and effectiveness in children have not been established.

Cautious Use

Significant bladder obstruction, closed-angle glaucoma; BPH; ulcerative colitis, GERD, intestinal atony; myasthenia gravis, autonomic neuropathy; moderate or severe hepatic dysfunction; severe renal insufficiency, renal failure; glaucoma; older adults; lactation.

Route & Dosage

Overactive Bladder
Adult: PO 20 mg twice daily OR 60 mg (extended release) daily
Geriatric (≥75 y): PO 20 mg once daily at bedtime if anticholinergic adverse effects are intolerable

Renal Impairment
Cl_cr <30 mL/min: 20 mg once daily at bedtime

Administration

Oral

Give at least 1 h before meals or on an empty stomach.
Store at 20°–25° C (66°–77° F).

Adverse Effects (≥1%)

Body as a Whole: Fatigue. CNS: Headache. GI: Dry mouth, constipation, abdominal pain, dyspepsia, flatulence. Special Senses: Dry eyes. Urogenital: Urinary retention.

Interactions

Drug: Increased anticholinergic adverse effects with anticholinergic agents.

Pharmacokinetics

Absorption: <10% absorbed orally. Peak: 5–6 h. Elimination: Primarily in feces (unabsorbed dose), renal tubular secretion of absorbed dose. Half-Life: 20 h.

Nursing Implications

Assessment & Drug Effects

Monitor bowel and bladder function. Report urinary hesitancy or significant constipation.
Withhold drug and notify physician if urinary retention develops.
Monitor for and report worsening of GI symptoms in those with GERD.
Frequent monitoring of IOP is required in those with controlled narrow-angle glaucoma.

Patient & Family Education

Report promptly any of the following: signs of an allergic reaction, (e.g., itching or hives), blurred vision or difficulty focusing, confusion, dizziness, difficulty passing urine.
Moderate intake of tea, coffee, caffeinated sodas, and alcohol to minimize side effects of this drug.
Avoid situations in which overheating is likely, as drug may impair sweating, which is a normal cooling mechanism.
Do not engage in hazardous activities until response to the drug is known.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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