I’ve been asked in the past about making recommendations with regards to urinary frequency. Trospium has an advantage over other anticholinergic agents that many do not know about or forget about. Before I discuss this advantage, I definitely want to encourage you to think about why a medication is necessary for overactive bladder/frequency symptoms.
Even before a bladder anticholinergic is added, one should first look at potential medications that may exacerbate symptoms of frequency or overactive bladder. Diuretics (loops, thiazides, etc.) are at the top of the list. While many diuretics are going to be necessary, ensure that everything is considered to eliminate them or at least find the minimum effective dose.
The acetylcholinesterase inhibitors (such as donepezil) can also cause urinary frequency type symptoms. Pay attention to the timing of these in relation to new symptoms. On rare occasions, I have seen a drug like pilocarpine (used for dry mouth) cause or exacerbate urinary symptoms as well.
When we’ve ruled out other causes and the patient and provider are in agreement that drug therapy is necessary, we start to look at different options in the anticholinergic group. Most often, drugs are selected by the comfort level of the provider as well as the cost of the medication. Age and mental status should also be a consideration and this is where trospium chloride (Sanctura) comes into play.
Trospium is a water-soluble anticholinergic with a positive charge, and thus less likely to have significant CNS penetration, leading to decreased CNS effects such as drowsiness, dizziness, and confusion. Patients who have cognitive impairment and/or a history of dementia would be strong candidates for using a drug like trospium. Cost may be an issue as mentioned previously but hopefully, this gives you some guidance on where this advantage of trospium may be extremely beneficial. We’ve provided a comparison of many of the urinary anticholinergics in a previous post which you can find here. It is definitely something I’d take a look at in preparation for the BCGP exam!