Urinary incontinence trospium chloride

Guay DRP. Trospium chloride an update on a quaternary anticholinergic for the treatment of urge urinary incontinence. Ther Clin Risk Manag 2005 1 157-166. 

Trospium chloride is an anticholinergic that antagonizes effects of acetylcholine on muscarinic receptors in cholin-ergically innervated organs. Its parasympatholytic action reduces tonus of smooth muscle in the bladder. It is indicated in the treatment of overactive bladder with symptoms of urinary incontinence, urgency, and urinary frequency. 

Overactive urinary bkuMer disease can be successfully treated with muscarinic antagonists, primarily tolterodine and trospium chloride, which lower intravesicular pressure, increase capacity, and reduce the frequency of contractions by antagonizing parasympathetic control of the bladder. Oxybu-tynin is used as a transdermal system (oxytrol) that delivers 3.9 mg/day and is associated with a lower incidence of side effects than the oral immediate- or extended-release formulations. Tolterodine is metabolized by CYP2D6 to a 5-hydroxymethyl metabolite since this metabolite possesses similar activity to the parent drug, variations in CYP2D6 levels do not affect the duration of drug action. Trospium is as effective as oxybutynin, with better tolerability. Solifenacin is newly approved for overactive bladder with a favorable efficacy side effect ratio. Stress urinary incontinence has been treated with some success with duloxetine (YENTREVE), which acts centrally to influence 5-HT and NE levels. 

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