TROSIGLEN 20

Indications

• Urinary frequency
• Urinary urgency
• Urge incontinence

Dosage

Children: For children, dosing information should be referred to the BNF for Children. Specific dosing details are not provided in the current BNF text.

Adults: For adults, the recommended dose is 60 mg once daily for modified-release formulations. For immediate-release formulations, the dose is reduced to 20 mg twice daily.

Mechanism of action

Trospium chloride acts as a competitive antagonist of muscarinic receptors (M1, M2, and M3 subtypes) in the bladder. By blocking these receptors, it reduces the involuntary contractions of the bladder muscle, thereby increasing bladder capacity and decreasing the sensation of urgency.

Pharmacodynamics

Trospium chloride exhibits its pharmacological effects through the inhibition of acetylcholine binding to muscarinic receptors, which leads to decreased smooth muscle tone in the bladder. This reduction in bladder activity helps alleviate symptoms associated with overactive bladder disorders.

Pharmacokinetics

Trospium chloride has a bioavailability of approximately 10-20% due to extensive first-pass metabolism. It is primarily excreted unchanged in the urine, with a half-life of about 20 hours. Peak plasma concentrations are typically reached within 5-6 hours after oral administration. Adjustments in dosing may be necessary for patients with renal impairment due to altered clearance.

Adverse effects

• Abdominal pain
• Bronchitis
• Chest pain
• Diarrhoea
• Dry eye
• Fatigue
• Gastrointestinal disorders
• Paraesthesia
• Peripheral oedema
• Vertigo
• Hallucination
• Memory loss
• Nervousness
• Rash
• Dyspepsia
• Dry mouth
• Constipation

Precautions

• History of QT-interval prolongation
• Caution in hepatic impairment
• Caution in renal impairment
• Caution advised during pregnancy and breastfeeding

Pregnancy

Manufacturer advises to avoid due to toxicity in animal studies.

Breast-feeding

Manufacturer advises to avoid; no information available.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Trospium chloride 60 mg modified-release capsules
• Trospium chloride 20 mg tablets

Mechanism of action

Trospium antagonizes the effect of acetylcholine on muscarinic receptors in cholinergically innervated organs. Its parasympatholytic action reduces the tonus of smooth muscle in the bladder.

Pharmacodynamics

Trospium is an antispasmodic, antimuscarinic agent indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. According to receptor assays, it displays higher affinity towards muscarininc receptors compared to nicotinic receptors at therapeutic concentrations.