Trospium Chloride in the Treatment of Overactive Bladder Syndrome and Detrusor Overactivity

• Published in: Advances in therapy Vol. 42; no. 9; pp. 4161 - 4187
• Main Authors: Truzzi, José C., Sartori, Marair G. F., Kemp, Vitorio L.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.09.2025
• Subjects: Benzilates - therapeutic use; Cardiology; Cholinergic Antagonists - adverse effects; Cholinergic Antagonists - therapeutic use; Endocrinology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Muscarinic Antagonists - adverse effects; Muscarinic Antagonists - therapeutic use; Nortropanes - adverse effects; Nortropanes - pharmacokinetics; Nortropanes - pharmacology; Nortropanes - therapeutic use; Oncology; Pharmacology/Toxicology; Review; Rheumatology; Urinary Bladder, Overactive - drug therapy; Polypharmacy; Urinary bladder; Drug interactions; Cholinergic antagonists; Cognition; Overactive; Dementia
• ISSN: 0741-238X; 1865-8652; 1865-8652
• DOI: 10.1007/s12325-025-03275-8

Trospium chloride (TCL) is a quaternary amine derived from atropine, classified as an oral anticholinergic, the class of drugs most commonly used in the treatment of overactive bladder syndrome (OAB) and detrusor overactivity (DO). It is a large and hydrophilic molecule, with a low water–oil partition coefficient, which hinders the passage through lipid membranes and has demonstrated poor penetration into the central nervous system (CNS), generally without deleterious effects on the cognitive functions of healthy patients or those already with dementia. This molecule is excreted practically unchanged in the urine, and the metabolized part undergoes spontaneous hydrolysis. Thus, it is subject to very few drug interactions in the metabolic process, favoring its application to polypharmacy user populations. Numerous randomized, placebo-controlled trials and post-marketing studies of TCL have demonstrated efficacy and safety, including long-term follow-up. Adverse events associated with the use of TCL are typical of those presented by antimuscarinic therapy, most commonly, dry mouth, with an incidence similar to that of other representatives of this class of drugs. So far, in general, TCL presents a favorable profile for the treatment of patients with OAB and DO. The study reviews literature specifically on TCL. While most available data stems from early studies conducted during its launch, the current investigation was prompted by renewed focus on the cognitive side effects of antimuscarinics. These effects are not limited to elderly patients but may also affect long-term users of this medication class. TCL emerges as a potentially safer option compared to many other antimuscarinics.