nach oben

Drugs

Erschienen in:

01.11.2004 | Review Article

Trospium Chloride in the Management of Overactive Bladder

verfasst von: Dr Eric S. Rovner

Erschienen in: Drugs | Ausgabe 21/2004

Einloggen, um Zugang zu erhalten

Abstract

Trospium chloride is an orally active, quaternary ammonium compound with antimuscarinic activity. It binds specifically and with high affinity to muscarinic receptors M₁, M₂ and M3, but not nicotinic, cholinergic receptors. It is hydrophilic and does not cross the normal blood-brain barrier in significant amounts and, therefore, has minimal central anticholinergic activity.

Peak plasma trospium chloride concentrations are attained approximately 5–6 hours after oral administration, which should occur before meals as concurrent food ingestion significantly reduces trospium bioavailability. Trospium chloride undergoes negligible metabolism by the hepatic cytochrome P450 system; few metabolic drug interactions are known. While trospium chloride dosage adjustments based on age or sex appear unwarranted, such adjustments may be needed in patients with severe renal impairment.

Direct comparative studies in patients with overactive bladder indicate that trospium chloride is at least as effective as oxybutynin and tolterodine. Placebo-controlled studies have also confirmed the efficacy of trospium chloride in terms of improved urodynamic parameters; small-scale, noncomparative studies have documented significant trospium chloride-induced improvements in patients with reflex neurogenic bladder, postoperative bladder irritation and radiation-induced cystitis; and observational studies including >10 000 patients have also revealed favourable findings for trospium chloride, including a marked decrease in incontinence episodes and substantial improvement in health-related quality of life.

Trospium chloride is generally well tolerated, and significantly more so than immediate-release oxybutynin. The most frequent adverse events, occurring in >1% of trospium chloride-treated patients, are dry mouth, dyspepsia, constipation, abdominal pain and nausea.

Available for many years in several countries outside North America, trospium chloride is likely to develop an important role in the management of overactive bladder following its approval in the US on 28 May 2004.

Kelleher CJ. Economic and social impact of OAB. Eur Urol 2002; 1 Suppl. 1: 11–6

van Kerrebroeck P, Abrams P, Chaikin D, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2): 179–83PubMedCrossRef

Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001; 87(9): 760–6PubMedCrossRef

Wein AJ, Rovner ES. Definition and epidemiology of overactive bladder. Urology 2002; 60 (5 Suppl. 1): 7–12PubMedCrossRef

Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol 2003; 20(6): 327–36PubMed

Choo M-S, Lee YS, Kim S-W, et al. The prevalence of overactive bladder in Korea [abstract]. International Continence Society Meeting; 2001 Sep 18–21; Seoul

Homma Y, Yamaguchi O, Hayashi K, et al. Nation-wide epidemiologic survey on lower urinary tract symptoms in Japan [abstract]. International Continence Society Meeting; 2003 Oct 5–9; Florence

Hu TW, Wagner TH, Bentkover JD, et al. Estimated economic costs of overactive bladder in the United States. Urology 2003; 61(6): 1123–8PubMedCrossRef

Staskin DR, Wein AJ, Andersson KE, et al. Overview consensus statement. Urology 2002; 60 (5 Suppl. 1): 1–6PubMedCrossRef

10.

Ouslander JG. Management of overactive bladder. N Engl J Med 2004; 350(8): 786–99PubMedCrossRef

11.

Andersson KE, Hedlund P. Pharmacologic perspective on the physiology of the lower urinary tract. Urology 2002; 60 (5 Suppl. 1): 13–20PubMedCrossRef

12.

Igawa Y. Discussion: functional role of M (1), M (2), and M (3) muscarinic receptors in overactive bladder. Urology 2000; 55 (5A Suppl.): 47–9PubMedCrossRef

13.

Andersson K-E, Appell R, Awad S, et al., Pharmacologic treatment of urinary incontinence. In: Abrams P, Khoury S, Wein A, editors. Incontinence. Plymouth: Health Publication, 2002: 481–511

14.

Yoshimura N, Chancellor MB. Current and future pharmacological treatment for overactive bladder. J Urol 2002; 168(5): 1897–913PubMedCrossRef

15.

Andersson KE. New roles for muscarinic receptors in the pathophysiology of lower urinary tract symptoms. BJU Int 2000; 86 Suppl. 2: 36–42PubMed

16.

Chappie CR, Yamanishi T, Chess-Williams R. Muscarinic receptor subtypes and management of the overactive bladder. Urology 2002; 60 (5 Suppl. 1): 82–8CrossRef

17.

Hofner K, Oelke M, Machtens S, et al. Trospium chloride: an effective drug in the treatment of overactive bladder and detrusor hyperreflexia. World J Urol 2001; 19(5): 336–43PubMedCrossRef

18.

Pak RW, Petrou SP, Staskin DR. Trospium chloride: a quaternary amine with unique pharmacologie properties. Curr Urol Rep 2003; 4(6): 436–40PubMedCrossRef

19.

Cardozo L, Chappie CR, Toozs-Hobson P, et al. Efficacy of trospium chloride in patients with detrusor instability: a placebo-controlled, randomized, double-blind, multicentre clinical trial. BJU Int 2000; 85(6): 659–64PubMedCrossRef

20.

Pfeiffer A, Schmidt T, Holler T, et al. Effect of trospium Chloride on gastrointestinal motility in humans. Eur J Clin Pharmacol 1993; 44(3): 219–23PubMedCrossRef

21.

Pehl C, Wendl B, Kaess H, et al. Effects of two anticholinergic drugs, trospium chloride and biperiden, on motility and evoked potentials of the oesophagus. Aliment Pharmacol Ther 1998; 12(10): 979–84PubMedCrossRef

22.

Matzkies F, Murtz G, Giannetti B, et al. Ultrasound studies of the effect of trospium chloride on gall-bladder kinetics. Arzneimittelforschung 1992; 42(12): 1456–8PubMed

23.

Fröhlich G, Bulitta M, Strosser W. Trospium chloride in patients with detrusor overactivity: meta-analysis of placebocontrolled, randomized, double-blind, multi-center clinical trials on the efficacy and safety of 20mg trospium chloride twice daily. Int J Clin Pharmacol Ther 2002; 40(7): 295–303PubMed

24.

Herberg K-W. General and traffic safety and the effects of incontinence medication: new studies on the safety potential of urological anticholinergics. Med Welt 1999; 50: 217–22

25.

Pietzko A, Dimpfel W, Schwantes U, et al. Influences of trospium chloride and oxybutynin on quantitative EEG in healthy volunteers. Eur J Clin Pharmacol 1994; 47(4): 337–43PubMedCrossRef

26.

Todorova A, Vonderheid-Guth B, Dimpfel W. Effects of tolterodine, trospium chloride, and oxybutynin on the central nervous system. J Clin Pharmacol 2001; 41(6): 636–44PubMedCrossRef

27.

Fusgen I, Hauri D. Trospium chloride: an effective option for medical treatment of bladder overactivity. Int J Clin Pharmacol Ther 2000; 38(5): 223–34PubMed

28.

Sanctura™ (trospium chloride) 20mg tablets [prescribing information]. Troisdorf: Maduas AG, 2004 Jul

29.

Ückert S, Stief CG, Odenthal KP, et al. Comparison of the effects of various spasmolytic drugs on isolated human and porcine detrusor smooth muscle. Arzneimittelforschung 1998; 48(8): 836–9PubMed

30.

Ückert S, Stief CG, Odenthal KP, et al. Responses of isolated normal human detrusor muscle to various spasmolytic drugs commonly used in the treatment of the overactive bladder. Arzneimittelforschung 2000; 50(5): 456–60PubMed

31.

Eckert R, Wilhelm A, Schwantes U, et al. Modulation of the cytoplasmic Ca2+ concentration in isolated myocytes of the bladder by anticholinergic agents. Aktuelle Urol 1995; 26: 4–6CrossRef

32.

Antweiler HF, Lauterbach F, Lehmann HD, et al. Pharmacology and toxicology of azoniaspirans of the nortropin or pseudonortropin series [in German]. Arzneimittelforschung 1966; 16: 1581–91

33.

Brown JH, Taylor P. Muscarinic receptor agonists and antagonists. In: Hardman JG, Limbird LE, Gilman AG, editors. Goodman and Gilman’s the pharmacological basis for therapeutics. New York: McGraw-Hill, 1996: 141–60

34.

Schwantes U, Topfmeier P. Importance of pharmacological and physicochemical properties for tolerance of antimuscarinic drugs in the treatment of detrusor instability and detrusor hyperreflexia: chances for improvement of therapy. Int J Clin Pharmacol Ther 1999; 37(5): 209–18PubMed

35.

Diefenbach K, Donath F, Maurer A, et al. Randomised, double-blind study of the effects of oxybutynin, tolterodine, trospium chloride and placebo on sleep in healthy young volunteers. Clin Drug Invest 2003; 23(6): 395–404CrossRef

36.

Diefenbach K, Arold G, Wollny A, et al. The influence of anticholinergics used in incontinence on sleep in healthy volunteers aged 50 years and older [abstract]. Joint Meeting of the International Continence Society and the International Uro-Gynecological Association; 2004 Aug 25–27; Paris

37.

Edwards KR, O’Connor JT. Risk of delirium with concomitant use of tolterodine and acetylcholinesterase inhibitors [letter]. J Am Geriatr Soc 2002; 50(6): 1165–6PubMedCrossRef

38.

Zerres K, Zaigler M, Reitbrock S, et al. Pharmacokinetics of single- and multiple-dose trospium chloride in elderly volunteers using a replicative design [abstract no. 687]. Naunyn Schmiedebergs Arch Pharmacol 1998; 357 Suppl. 4: R175

39.

Schladitz-Keil G, Spahn H, Mutschier E. Determination of the bioavailability of the quaternary compound trospium chloride in man from urinary excretion data. Arzneimittelforschung 1986; 36(6): 984–7PubMed

40.

Guay DRP. Clinical pharmacokinetics of drugs used to treat urge incontinence. Clin Pharmacokinet 2003; 42(14): 1243–85PubMedCrossRef

41.

Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Inhibitory effects of trospium chloride on cytochrome P450 enzymes in human liver microsomes. Pharmacol Toxicol 1999; 85(6): 299–304PubMedCrossRef

42.

UK Medicines Information Pharmacists Group. Trospium monograph. Northern Ireland and Wales: UK Medicines Information, 2002

43.

Sandage B, Najarian N, Lasseter K. The effect of hepatic disease on the pharmacokinetics of trospium chloride [abstract]. Annual Meeting of the International Continence Society; 2004 Aug 23–27; Paris

44.

Zinner N, Gittelman M, Harris R, et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol 2004; 171 (6 Pt 1): 2311–5PubMedCrossRef

45.

Rudy D, Cline K, Goldberg K, et al. A multicenter, randomized, placebo-controlled trial of trospium chloride in overactive bladder patients [abstract]. Annual Meeting of the International Continence Society; 2004 Aug 23–27; Paris

46.

Alloussi S, Laval K-U, Eckert R, et al. Trospium chloride (Spasmo-Lyt®) in patients with motor urge symptoms (detrusor instability): a double-blind, randomised, multicentre, placebo-controlled study. J Drug Assess 1999; 2 (Pt 1): 27–39

47.

Stöhrer M, Bauer P, Giannetti BM, et al. Effect of trospium chloride on urodynamic parameters in patients with detrusor hyperreflexia due to spinal cord injuries: a multicentre placebo-controlled double-blind trial. Urol Int 1991; 47(3): 138–43PubMedCrossRef

48.

Ulshöfer B, Bihr A-M, Bödeker R-H, et al. Randomised, double-blind, placebo-controlled study on the efficacy and tolerance of trospium chloride in patients with motor urge incontinence. Clin Drug Invest 2003; 21(8): 563–9

49.

Stöhrer M, Bersch U, Gocking K, et al. Dose finding study for treatment of detrusor hyperreflexia by trospium chloride [abstract]. 37 th Annual Scientific Meeting of the International Medical Society of Paraplegia; 1998 Jun 18–20; Foz do Iguacu

50.

Lopez Pereira P, Miguelez C, Caffarati J, et al. Trospium chloride for the treatment of detrusor instability in children. J Urol 2003; 170(5): 1978–81PubMedCrossRef

51.

Halaska M, Ralph G, Wiedemann A, et al. Controlled, doubleblind, multicentre clinical trial to investigate long-term tolerability and efficacyof trospium chloride in patients with detrusor instability. World J Urol 2003; 20(6): 392–9PubMed

52.

Madersbacher H, Stöhrer M, Richter R, et al. Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia. Br J Urol 1995; 75(4): 452–6PubMedCrossRef

53.

Osca-Garcia JM, Martinez-Aguilo E, Conejero-Sugranes J, et al. A comparison of trospium chloride and oxybutinin in the treatment of hyperactive bladder: a randomized double-blind study. Urod A 1997; 10: 40–4

54.

Fröhlich G, Burmeister S, Wiedemann A, et al. Intravesical instillation of trospium chloride, oxybutynin and verapamil for relaxation of the bladder detrusor muscle: a placebo controlled, randomized clinical test [in German]. Arzneimittelforschung 1998; 48(5): 486–91PubMed

55.

Jünemann KP, Al-Shukri S. Efficacy and tolerability of trospium chloride and tolterodine in 234 patients with urge syndrome: a double-blind, placebo-controlled, multicentre, clinical trial [abstract]. Neurourol Urodyn 2000; 19(4): 488–90

56.

Seidel D, Ozman AS, Hulsbusch R. Bladder disorders in multiple sclerosis. Med Welt 1990; 41: 1053–5

57.

Madersbacher H, Stöhrer M, Richter R, et al. High-dose trospium chloride in therapy of detrusor hyperreflexia [in German]. Urologe A 1991; 30(4): 260–3PubMed

58.

Madersbacher H, Rettig K. Trospium chloride in general practice therapeutic results from the treatment of irritable bladder symptoms and urge incontinence [in German]. Z Allgemeinmed 1997; 73: 378–83

59.

Madersbacher H, Stöhrer M, Murtz G, et al. Trospium chloride (Spasmo-lyt®): an effective drug in urge incontinence. Urologe B 1993; 33(2): 89–93

60.

Madersbacher H, Jahnig J, Rettig K. Irritable bladder symptoms and urge incontinence: effective therapy with Spasmo-Lyt coated tablets. Der Allgemeinarzt 1995; 4: 501–3

61.

Wiedemann A, Zumbe J, Rettig K, et al. Therapy of childhood incontinence with trospium chloride. Urologe B 1998; 38: 531–4CrossRef

62.

Hofner K, Wiedemann A, Zumbe J, et al. New aspects of the management of urge incontinence: quality of life, fluid intake and nursing care. Kassenarzt 1999; 12: 37–40

63.

Schwantes PA, Zellner M, Schwantes U, et al. Efficacy and acceptability of trospium chloride therapy in patients with urge incontinence. Acta Ther 1994; 20: 133–50

64.

Wiedemann A, Monser C, Braun W, et al. Socio-economic aspects of urinary incontinence: savings potential through anti-cholinergics. Urologe B 1998; 38: 154–9CrossRef

65.

Wiedemann A, Zumbe J, Fusgen I. Urge incontinence: anticholinergic therapy is efficient and reduces costs. Der Allgemeinarzt 1999; 21: 1109–12

66.

Lux B, Wiedey KD. Trospium chloride (Spasmex®) in the treatment of urinary incontinence. Therapiewoche 1992; 42(6): 302–7

67.

Breuel HP, Murtz G, Bondy S, et al. Safety and tolerance of trospium chloride in the high dose range. Arzneimittelforschung 1993; 43(4): 461–4PubMed

Titel: Trospium Chloride in the Management of Overactive Bladder
verfasst von: Dr Eric S. Rovner
Publikationsdatum: 01.11.2004
Verlag: Springer International Publishing
Erschienen in: Drugs / Ausgabe 21/2004
Print ISSN: 0012-6667
Elektronische ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200464210-00005

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Trospium Chloride in the Management of Overactive Bladder

Abstract

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 21/2004

Topical Antibacterial Therapy for Acne Vulgaris

Therapeutic Potential of Oral Antiproliferative Agents in the Prevention of Coronary Restenosis

Long-Cycle Treatment with Oral Contraceptives

Progesterone Treatment to Prevent Preterm Birth

Aspirin-Induced Asthma

Management of Acute and Chronic Gouty Arthritis