Trospium Chloride

Trospium chloride (Sanctura) is an antimuscarinic agent with atropine-like effects that has no selectivity for the M1 to M5 receptors subtypes. It has been used in many forms in Europe for several years, and was recently FDA approved in the United States. It is different from traditional antimuscarinics in its unique large molecular size that prevents it from crossing the blood-brain barrier, thus minimizing central anticholinergic side effects. Additionally, 80% of an oral dose of the drug is excreted as the active compound in the urine, thus directly contacting the urothelium and possibly accounting for the favorable effects on the bladder and the limited effects on the salivary glands.

Controlled trials of trospium indicated a statistically significant improvement in volume to first contraction and bladder capacity compared with placebo with a subjective symptomatic improvement threefold greater.17

Hofner et al.18 compared trospium to oxybutynin in a multicenter trial, and found that maximum bladder capacity, volume at first unstable contraction, and volume at first desire to void, were improved without any statistical difference between the arms. Adverse events were less frequent in the trospium group (47.9% vs. 58.9% for trospium and oxybutynin, respectively; P = .002) and xerostomia was significantly decreased (33% vs. 50%, trospium and oxy-butynin, respectively; P < .01).18,19

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