Names and pronunciation
(trose′pee-um) Trosec
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Drug reference
(trose′pee-um) Trosec
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Func. class.: Anticholinergic, urinary antispasmodic T
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Chem. class.: Muscarinic receptor antagonist
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ACTION: Relaxes smooth muscles in bladder by inhibiting acetylcholine effect on muscarinic receptors
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USES: Overactive bladder (urinary frequency, urgency)
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CONTRAINDICATIONS: Hyper- sensitivity, uncontrolled closed-angle glaucoma, urinary retention, gastric retention, myasthenia gravis Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal/hepatic disease, controlled closed-angle glau- coma, ulcerative colitis, intestinal atony, bladder outflow obstruction
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SIDE EFFECTS CNS: Fatigue, dizziness, headache, confusion CV: Tachycardia EENT: Dry eyes, vision abnormalities GI: Flatulence, abdominal pain, consti- pation, dry mouth, dyspepsia GU: Urinary retention, UTI INTEG: Dry skin, angioedema MISC: Heat stroke, fever
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INTERACTIONS Increase: drowsiness—CNS depressants, alcohol Increase or decrease: trospium effect— products excreted by active renal secretion (aMILoride, digoxin, morphine), metFOR- MIN, quiNIDine, procainamide, raNITIdine, tenofovir, triamterene, vancomycin Drug/Food Decrease: absorption—high-fat meal
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DOSAGE AND ROUTES • Adult <75 yr: PO 20 mg bid 1 hr be- fore meals or on empty stomach; EXT REL 60 mg in AM • Geriatric ≥75 yr: PO titrate down to 20 mg/day based on response and tolerance Renal dose • Adult: PO CCr <30 mL/min, 20 mg/day at bedtime, ext rel product not recom mended
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Available forms: Tabs 20 mg; caps ext rel 60 mg
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Administer: • 1 hr before meals or on empty stomach (reg rel); in AM (ext rel) ≥1 hr before meal
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Assess: • Urinary patterns: I&O ratio, CCr base- line and periodically, post-void residual distention, nocturia, frequency, urgency, incontinence, voiding patterns • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excreted in breast milk • Beers: avoid in older adults with de- lirium or at high risk for delirium
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Evaluate: • Therapeutic response: correction of urinary status: absence of dysuria, fre- quency, nocturia, incontinence
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid hazardous activities because dizziness may occur • That alcohol may increase drowsiness • About anticholinergic effects that may occur • That overheating may occur with strenuous exercise • To avoid all other products unless ap- proved by prescriber • To use hard candy for dry mouth (most common side effect) HIGH ALERT
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PHARMACOKINETICS Rapidly absorbed (10%); peak 5-6 hr; protein bound (50%-85%); extensively metabolized; excreted in urine, feces; excreted in urine by active tubular secre- tion; half-life 20 hr
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• Adult <75 yr: PO 20 mg bid 1 hr be- fore meals or on empty stomach; EXT REL 60 mg in AM
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• Adult: PO CCr <30 mL/min, 20 mg/day at bedtime, ext rel product not recom mended
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