Trospium

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# Overview
Trospium is a muscarinic antagonist that is FDA approved for the treatment of overactive bladder.   Common adverse reactions include dry mouth, constipation, and headache.

# Adult Indications and Dosage

## FDA-Labeled Indications and Dosage (Adult)

### Indications
- SANCTURA is a muscarinic antagonist indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.

### Dosage
- The recommended dose is 20 mg twice daily. SANCTURA should be dosed at least one hour before meals or given on an empty stomach.
- For patients with severe renal impairment (creatinine clearance less than 30 mL/min), the recommended dose is 20 mg once daily at bedtime.
- In geriatric patients greater than or equal to 75 years of age, dose may be titrated down to 20 mg once daily based upon tolerability

### DOSAGE FORMS AND STRENGTHS
- SANCTURA is supplied as 20 mg tablets (brownish yellow, biconvex, glossy coated tablets printed with S in black ink)

## Off-Label Use and Dosage (Adult)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Trospium in adult patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Trospium in adult patients.

# Pediatric Indications and Dosage

## FDA-Labeled Indications and Dosage (Pediatric)
There is limited information regarding FDA-Labeled Use of Trospium in pediatric patients.

## Off-Label Use and Dosage (Pediatric)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Trospium in pediatric patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Trospium in pediatric patients.

# Contraindications
- SANCTURA is contraindicated in patients with:

# Warnings
- SANCTURA should be administered with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention
- Angioedema of the face, lips, tongue, and/or larynx has been reported with trospium chloride, the active ingredient in SANCTURA. In one case, angioedema occurred after the first dose of trospium chloride. Angioedema associated with upper airway swelling may be life threatening. If involvement of the tongue, hypopharynx, or larynx occurs, SANCTURA should be promptly discontinued and appropriate therapy and/or measures necessary to ensure a patent airway should be promptly provided.
- SANCTURA should be administered with caution to patients with gastrointestinal obstructive disorders because of the risk of gastric retention. SANCTURA, like other antimuscarinic agents, may decrease gastrointestinal motility and should be used with caution in patients with conditions such as ulcerative colitis, intestinal atony and myasthenia gravis.
- In patients being treated for narrow-angle glaucoma, SANCTURA should only be used if the potential benefits outweigh the risks and in that circumstance only with careful monitoring.
- SANCTURA is associated with anticholinergic central nervous system (CNS) effects. A variety of CNS anticholinergic effects have been reported, including dizziness, confusion, hallucinations and somnolence. Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. Advise patients not to drive or operate heavy machinery until they know how SANCTURA affects them. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered.
- Trospium is substantially excreted by the kidney. The effects of moderate renal impairment on systemic exposure are not known, but systemic exposure is likely increased. Therefore, anticholinergic adverse reactions (including dry mouth, constipation, dyspepsia, urinary tract infection, and urinary retention) are expected to be greater in patients with moderate renal impairment

# Adverse Reactions

## Clinical Trials Experience
- Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
- The safety of SANCTURA was evaluated in controlled clinical trials in a total of 2975 patients, who were treated with SANCTURA (N=1673), placebo (N=1056) or active control medications (N=246). Of this total, 1181 patients participated in two, 12-week, U.S., efficacy and safety studies and a 9-month open-label extension. Of this total, 591 patients received SANCTURA 20 mg twice daily. In all controlled trials combined, 232 and 208 patients received treatment with SANCTURA for at least 24 and 52 weeks, respectively.
- In all placebo-controlled trials combined, the incidence of serious adverse events was 2.9% among patients receiving SANCTURA 20 mg twice daily and 1.5% among patients receiving placebo. TABLE 1 lists adverse reactions from the combined 12-week U.S. safety and efficacy trials were reported by at least 1% of patients, and were reported more frequently in the SANCTURA group than in the placebo group.
- The two most common adverse reactions reported by patients receiving SANCTURA 20 mg twice daily were dry mouth and constipation. The single most frequently reported adverse reaction for SANCTURA, dry mouth, occurred in 20.1% of SANCTURA treated patients and 5.8% of patients receiving placebo. In the two U.S. studies, dry mouth led to discontinuation in 1.9% of patients treated with SANCTURA 20 mg twice daily. For the patients who reported dry mouth, most had their first occurrence of the event within the first month of treatment.
- Other adverse reactions from the U.S., placebo-controlled trials , occurring in greater than or equal to 0.5% and less than 1.0% of SANCTURA treated patients, and more common with SANCTURA than placebo are: tachycardia, blurred vision , abdominal distension, vomiting, dysgeusia, dry throat, and dry skin.
- During controlled clinical studies, one adverse reaction of angioneurotic edema was reported.

## Postmarketing Experience
- The following adverse reactions have been identified during post-approval use of trospium chloride. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- gastritis
- palpitations
- supraventricular tachycardia
- chest pain
- syncope
- hypertensive crisis
- Stevens-Johnson syndrome
- anaphylactic reaction
- angioedema
- dizziness
- confusion
- abnormal vision
- hallucinations
- somnolence
- delirium
- rhabdomyolysis
- rash

# Drug Interactions
- Concomitant use of SANCTURA and digoxin did not affect the pharmacokinetics of either drug.
- Although demonstrated in a drug-drug interaction study not to affect the pharmacokinetics of digoxin, SANCTURA has the potential for pharmacokinetic interactions with other drugs that are eliminated by active tubular secretion (e.g., procainamide, pancuronium, morphine, vancomycin, and tenofovir). Coadministration of SANCTURA with these drugs may increase the serum concentration of SANCTURA and/or the coadministered drug due to competition for this elimination pathway. Careful patient monitoring is recommended in patients receiving such drugs.
- The concomitant use of SANCTURA with other antimuscarinic agents that produce dry mouth, constipation, and other anticholinergic pharmacological effects may increase the frequency and/or severity of such effects. SANCTURA may potentially alter the absorption of some concomitantly administered drugs due to anticholinergic effects on gastrointestinal motility.
- Co-administration of 500 mg metformin immediate release tablets twice daily with SANCTURA XR (trospium chloride 60 mg extended release) reduced the steady-state systemic exposure of trospium by approximately 29% for mean AUC0-24 and by 34% for mean Cmax

# Use in Specific Populations

### Pregnancy
Pregnancy Category (FDA): C
- There are no adequate and well-controlled studies of SANCTURA in pregnant women. SANCTURA should be used during pregnancy only if the potential benefit to the patient outweighs the risk to the patient and fetus. Women who become pregnant during SANCTURA treatment are encouraged to contact their physician.
- Based on animal data, trospium chloride is predicted to have a low probability of increased risk of adverse developmental outcomes, above background risk. Adverse developmental findings were not observed to correlate with dose in rats or in rabbits. No increased risk above background was observed in rats and rabbits treated at an exposure approximately equivalent to the maximal recommended human dose (MRHD) of 40 mg.
- In a rat embryo/fetal development study, pregnant rats received doses of trospium chloride up to 200 mg/kg/day, from implantation to closure of the fetal hard palate, with maternal systemic exposures corresponding to approximately nine times the exposure of women treated at the MRHD of 40 mg, based on AUC. No malformations or fetal toxicity were observed.
- The offspring of female rats exposed orally, pre- and post-natally, to trospium chloride up to 200 mg/kg/day showed no increased developmental toxicity over background in surviving pups. However, maternal toxicity (death, irregular breathing, increased excitability) was observed at 200 mg/kg/day. A no-effect level for maternal and pup toxicity (survival to Day 4) was 20 mg/kg/day, an exposure approximately equivalent to the maximal recommended human dose (MRHD) of 40 mg.
- In a rabbit embryo/fetal development study, pregnant rabbits received doses of trospium chloride up to 200 mg/kg/day, from implantation to closure of the fetal hard palate. At 200 mg/kg/day, maternal systemic exposures corresponded to approximately 16 times the exposure of women treated at the MRHD of 40 mg, based on AUC. However, one fetus in each of the three treated dose groups (0.3 to 16 times exposures at the MRHD) demonstrated multiple malformations, including umbilical hernia and skeletal malformations. A maternal no-effect level was set at 20 mg/kg/day, at an exposure approximately equivalent to the maximal recommended human dose (MRHD) of 40 mg, due to clinical signs (reduced feces, hunched posture, diarrhea) observed in a pharmacokinetic study at 200 mg/kg/day.
Pregnancy Category (AUS):
- Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Trospium in women who are pregnant.

### Labor and Delivery
- The effect of SANCTURA tablets on labor and delivery is unknown.

### Nursing Mothers
- Trospium chloride (2 mg/kg orally and 50 mcg/kg intravenously) was excreted, to a limited extent (less than 1%), into the milk of lactating rats (primarily as parent compound). It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, SANCTURA should be used during lactation only if the potential benefit justifies the potential risk to the newborn.

### Pediatric Use
- The safety and effectiveness of SANCTURA in pediatric patients have not been established.

### Geriatic Use
- Of the 591 patients with overactive bladder who received treatment with SANCTURA in the two U.S., placebo-controlled, efficacy and safety studies, 249 patients (42%) were 65 years of age and older. Eighty-eight SANCTURA treated patients (15%) were greater than or equal to 75 years of age.
In these 2 studies, the incidence of commonly reported anticholinergic adverse reactions in patients treated with SANCTURA (including dry mouth, constipation, dyspepsia, urinary tract infection, and urinary retention) was higher in patients 75 years of age and older as compared to younger patients. This effect may be related to an enhanced sensitivity to anticholinergic agents in this patient population. Therefore, based upon tolerability, the dose frequency of SANCTURA may be reduced to 20 mg once daily in patients 75 years of age and older.

### Gender
There is no FDA guidance on the use of Trospium with respect to specific gender populations.

### Race
There is no FDA guidance on the use of Trospium with respect to specific racial populations.

### Renal Impairment
Severe renal impairment (creatinine clearance less than 30 mL/minute) significantly altered the disposition of SANCTURA. A 4.2-fold and 1.8-fold increase in mean AUC(0-) and Cmax, respectively, and the appearance of an additional elimination phase with a long half-life (~33 hr) were detected in patients with severe renal impairment compared with nearly age-matched subjects with creatinine clearance equal to or higher than 80 mL/min. The different pharmacokinetic behavior of SANCTURA in patients with severe renal impairment necessitates adjustment of dosage frequency. The pharmacokinetics of trospium have not been studied in patients with creatinine clearance ranging from 30-80 mL/min.
- Trospium is known to be substantially excreted by the kidney, and the risk of adverse reactions may be greater in patients with impaired renal function.

### Hepatic Impairment
- There is no information regarding the effect of severe hepatic impairment on exposure to SANCTURA. In a study of patients with mild and with moderate hepatic impairment, given 40 mg of immediate-release trospium chloride, mean Cmax increased 12% and 63%, respectively, and mean AUC(0-) decreased 5% and 15%, respectively, compared to healthy subjects. The clinical significance of these findings is unknown. Caution should be used when administering SANCTURA to patients with moderate and severe hepatic impairment.

### Females of Reproductive Potential and Males
There is no FDA guidance on the use of Trospium in women of reproductive potentials and males.

### Immunocompromised Patients
There is no FDA guidance one the use of Trospium in patients who are immunocompromised.

# Administration and Monitoring

### Administration
- Oral

### Monitoring
- Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose.

# IV Compatibility
There is limited information regarding IV Compatibility of Trospium in the drug label.

# Overdosage
- Overdosage with antimuscarinic agents, including SANCTURA, can result in severe antimuscarinic effects. Supportive treatment should be provided according to symptoms. In the event of overdosage, electrocardiographic monitoring is recommended.
- A 7-month-old baby experienced tachycardia and mydriasis after administration of a single dose of trospium 10 mg given by a sibling. The baby's weight was reported as 5 kg. Following admission into the hospital and about 1 hour after ingestion of the trospium, medicinal charcoal was administered for detoxification. While hospitalized, the baby experienced mydriasis and tachycardia up to 230 beats per minute. Therapeutic intervention was not deemed necessary. The baby was discharged as completely recovered the following day.

# Pharmacology

## Mechanism of Action
- SANCTURA is a muscarinic antagonist.
- Trospium chloride antagonizes the effect of acetylcholine on muscarinic receptors in cholinergically innervated organs including the bladder. Its parasympatholytic action reduces the tonus of smooth muscle in the bladder.
- Receptor assays showed that trospium chloride has negligible affinity for nicotinic receptors as compared to muscarinic receptors at concentrations obtained from therapeutic doses.

## Structure
- SANCTURA (trospium chloride) is a quaternary ammonium compound with the chemical name of Spirooctane-8,1'-pyrrolidinium], 3--, chloride, (1, 3, 5). The empirical formula of trospium chloride is C25H30ClNO3 and its molecular weight is 427.97. The structural formula of trospium chloride is represented below:
- Trospium chloride is a fine, colorless to slightly yellow, crystalline solid. The compound's solubility in water is approximately 1 g per 2 mL.
- Each SANCTURA tablet contains 20 mg of trospium chloride, a muscarinic antagonist, for oral administration. Each tablet also contains the following inactive ingredients: sucrose, wheat starch, microcrystalline cellulose, talc, lactose monohydrate, calcium carbonate, titanium dioxide, stearic acid, croscarmellose sodium, povidone, polyethylene glycol 8000, colloidal silicon dioxide, ferric oxide, carboxymethylcellulose sodium, white wax, magnesium stearate, and carnauba wax.

## Pharmacodynamics
- Placebo-controlled studies employing urodynamic variables were conducted in patients with conditions characterized by involuntary detrusor contractions. The results demonstrate that SANCTURA increases maximum cystometric bladder capacity and volume at first detrusor contraction.
- The effect of 20 mg twice daily and up to 100 mg twice daily SANCTURA on QT interval was evaluated in a single-blind, randomized, placebo and active (moxifloxacin 400 mg once daily) controlled 5 day parallel trial in 170 male and female healthy volunteer subjects aged 18 to 45 years. The QT interval was measured over a 24-hour period at steady state. The 100 mg twice daily dose of SANCTURA was chosen because this achieves the Cmax expected in severe renal impairment. SANCTURA was not associated with an increase in individual corrected (QTcI) or Fridericia corrected (QTcF) QT interval at any time during steady state measurement, while moxifloxacin was associated with a 6.4 msec increase in QTcF.
- In this study, asymptomatic, non-specific T wave inversions were observed more often in subjects receiving SANCTURA than in subjects receiving moxifloxacin or placebo following five days of treatment. This finding was not observed during routine safety monitoring in 2 other placebo-controlled clinical trials in 591 SANCTURA treated overactive bladder patients. The clinical significance of T wave inversion in this study is unknown. SANCTURA is associated with an increase in heart rate that correlates with increasing plasma concentrations. In the study described above, SANCTURA demonstrated a mean increase in heart rate compared to placebo of 9.1 bpm for the 20 mg dose and of 18 bpm for the 100 mg dose. In the two U.S. placebo-controlled trials in patients with overactive bladder, the mean increase in heart rate compared to placebo in Study 1 was observed to be 3 bpm and in Study 2 was 4 bpm.

## Pharmacokinetics
- After oral administration, less than 10% of the dose is absorbed. Mean absolute bioavailability of a 20 mg dose is 9.6% (range: 4-16.1%). Peak plasma concentrations (Cmax) occur between 5 to 6 hours post-dose. Mean Cmax increases greater than dose-proportionally; a 3-fold and 4-fold increase in Cmax was observed for dose increases from 20 mg to 40 mg and from 20 mg to 60 mg, respectively. AUC exhibits dose linearity for single doses up to 60 mg. SANCTURA exhibits diurnal variability in exposure with a decrease in Cmax and AUC of up to 59% and 33%, respectively, for evening relative to morning doses.
- Administration with a high (50%) fat-content meal resulted in reduced absorption, with AUC and Cmax values 70-80% lower than those obtained when SANCTURA was administered while fasting. Therefore, it is recommended that SANCTURA should be taken at least one hour prior to meals or on an empty stomach.
- A summary of mean ( standard deviation) pharmacokinetic parameters for a single 20 mg dose of SANCTURA is provided in TABLE 2.
- Protein binding ranged from 50 to 85% when concentration levels of trospium chloride (0.5-50 ng/mL) were incubated with human serum in vitro.
- The 3H-trospium chloride ratio of plasma to whole blood was 1.6:1. This ratio indicates that the majority of 3H-trospium chloride is distributed in plasma.
- The apparent volume of distribution for a 20 mg oral dose is 395 ( 140) liters.
- The metabolic pathway of trospium in humans has not been fully defined. Of the 10% of the dose absorbed, metabolites account for approximately 40% of the excreted dose following oral administration. The major metabolic pathway is hypothesized as ester hydrolysis with subsequent conjugation of benzylic acid to form azoniaspironortropanol with glucuronic acid. Cytochrome P450 (CYP) is not expected to contribute significantly to the elimination of trospium. Data taken from in vitro human liver microsomes investigating the inhibitory effect of trospium on seven CYP isoenzyme substrates (CYP1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4) suggest a lack of inhibition at clinically relevant concentrations.
- The plasma half-life for SANCTURA following oral administration is approximately 20 hours. After oral administration of an immediate-release formulation of 14C-trospium chloride, the majority of the dose (85.2%) was recovered in feces and a smaller amount (5.8% of the dose) was recovered in urine; 60% of the radioactivity excreted in urine was unchanged trospium.
- The mean renal clearance for trospium (29.07 L/hour) is 4-fold higher than average glomerular filtration rate, indicating that active tubular secretion is a major route of elimination for trospium. There may be competition for elimination with other compounds that are also renally eliminated.
- Concomitant use of 20 mg SANCTURA (trospium chloride immediate release) twice daily at steady state and a single dose of 0.5 mg digoxin in a crossover study with 40 male and female subjects did not affect the pharmacokinetics of either drug.
- A drug interaction study was conducted in which SANCTURA XR 60 mg once daily was co-administered with Glucophage (metformin hydrochloride) 500 mg twice daily under steady-state conditions in 44 healthy subjects. Co-administration of 500 mg metformin immediate release tablets twice daily reduced the steady-state systemic exposure of trospium by approximately 29% for mean AUC0-24 and by 34% for mean Cmax. The effect of decrease in trospium exposure on the efficacy of SANCTURA XR is unknown. The steady-state pharmacokinetics of metformin were comparable when administered with or without 60 mg SANCTURA XR once daily under fasted condition. The effect of metformin at higher doses on trospium PK is unknown.
- Age: Age did not appear to significantly affect the pharmacokinetics of SANCTURA, however, increased anticholinergic side effects unrelated to drug exposure were observed in patients greater than or equal to 75 years of age.
- Pediatric: The pharmacokinetics of SANCTURA were not evaluated in pediatric patients.
- Race: Pharmacokinetic differences due to race have not been studied.
- Gender: Studies comparing the pharmacokinetics in different genders had conflicting results. When a single 40 mg SANCTURA dose was administered to 16 elderly subjects, exposure was 45% lower in elderly females compared to elderly males. When 20 mg SANCTURA was dosed twice daily for 4 days to 6 elderly males and 6 elderly females (60 to 75 years), AUC and Cmax were 26% and 68% higher, respectively, in females without hormone replacement therapy than in males.
- Renal Impairment: In a clinical pharmacokinetic study where a single dose of 40 mg immediate release trospium chloride was administered to 12 healthy males and 12 males with severe renal impairment, severe renal impairment (creatinine clearance less than 30 mL/minute) significantly altered the disposition of SANCTURA. A 4.2-fold and 1.8-fold increase in mean AUC(0-) and Cmax, respectively, and the appearance of an additional elimination phase with a long half-life (~33 hours vs. 18 hours) were detected in patients with severe renal impairment compared with nearly age-matched subjects with creatinine clearance equal to or higher than 80 mL/min. The different pharmacokinetic behavior of SANCTURA in patients with severe renal impairment necessitates adjustment of dosage frequency. The pharmacokinetics of trospium have not been studied in patients with creatinine clearance ranging from 30-80 mL/min.
- Hepatic Impairment: In a clinical pharmacokinetic study in patients with mild (Child-Pugh score 5-6) and with moderate (Child-Pugh score 7-8) hepatic impairment, given a single dose of 40 mg immediate-release trospium chloride, mean Cmax increased 12% and 63%, respectively, and mean AUC(0-) decreased 5% and 15%, respectively, compared to healthy subjects. There is no information regarding the effect of severe hepatic impairment on exposure to SANCTURA.

## Nonclinical Toxicology
- Carcinogenicity studies with trospium chloride were conducted in mice and rats for 78 weeks and 104 weeks, respectively, at maximally tolerated doses. No evidence of a carcinogenic effect was found in either mice or rats administered up to 200 mg/kg/day, approximately 9 times the expected clinical exposure levels at the maximum recommended human dose (MRHD) of 40 mg.
- Trospium chloride was not mutagenic nor genotoxic in tests in vitro in bacteria (Ames test) and mammalian cells (L5178Y mouse lymphoma and CHO cells) or in vivo in the rat micronucleus test.
- No evidence of impaired fertility was observed in rats administered doses up to 200 mg/kg/day (about 16 times the expected clinical exposure at the MRHD, based on AUC).

# Clinical Studies
- SANCTURA was evaluated for the treatment of patients with overactive bladder who had symptoms of urinary frequency, urgency, and urge incontinence in two U.S. 12-week, placebo-controlled studies and one 9-month open label extension.
- Study 1 was a randomized, double-blind, placebo-controlled, parallel-group study in 523 patients. A total of 262 patients received SANCTURA 20 mg twice daily and 261 patients received placebo. The majority of patients were Caucasian (85%) and female (74%) with a mean age of 61 years (range: 21 to 90 years). Entry criteria required that patients have urge or mixed incontinence (with a predominance of urge), urge incontinence episodes of at least 7 per week, and greater than 70 micturitions per week. The patient's medical history and urinary diary during the treatment-free baseline confirmed the diagnosis. Reductions in urinary frequency, urge incontinence episodes and urinary void volume for placebo and SANCTURA treatment groups are summarized in TABLE 3 and FIGURES 2 and 3.

# How Supplied
- SANCTURA tablets 20 mg (brownish yellow, biconvex, glossy coated tablets printed with S in black ink) are supplied as follows: 60 count HDPE bottle - NDC 0023-3513-60

## Storage
- Store at controlled room temperature 20 - 25C (68 - 77F)

# Images

## Drug Images

## Package and Label Display Panel

### PRINCIPAL DISPLAY PANEL

### Ingredients and Appearance

# Patient Counseling Information
- Patients should be informed that trospium chloride, the active ingredient in SANCTURA, may produce angioedema which could result in life-threatening airway obstruction. Patients should be advised to promptly discontinue SANCTURA and seek immediate medical attention if they experience edema of the tongue, edema of the laryngopharynx, or difficulty breathing.
- Prior to treatment, patients should fully understand the risks and benefits of SANCTURA. In particular, patients should be informed not to take SANCTURA tablets if they:
- have urinary retention;
- gastric retention;
- uncontrolled narrow-angle glaucoma;
- are allergic to any component of SANCTURA.
- Patients should be instructed regarding the recommended dosing and administration of SANCTURA:
- Take one SANCTURA tablet twice daily with water.
- Take SANCTURA on an empty stomach or at least 1 hour before a meal.
- Patients should be informed that the most common side effects with SANCTURA are dry mouth and constipation and that other less common side effects include trouble emptying the bladder, blurred vision, and heat prostration. Because anticholinergics, such as SANCTURA, may produce dizziness or blurred vision, patients should be advised to exercise caution in decisions to engage in potentially dangerous activities until the drug's effects have been determined. Patients should be informed that alcohol may enhance the drowsiness caused by anticholinergic agents.

### PATIENT PACKAGE INSERT

# Precautions with Alcohol
- Alcohol-Trospium interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

# Brand Names
- Sanctura

# Look-Alike Drug Names
There is limited information regarding Trospium Look-Alike Drug Names in the drug label.

# Drug Shortage Status

# Price