After the administration of a maximum single dose of 360 mg trospium chloride to healthy volunteers, dryness of the mouth, tachycardia and disorders of micturition were observed to an increased extent. No manifestations of severe overdosage or intoxication in humans have been reported to date. Increased anticholinergic symptoms are to be expected as signs of intoxication.
In the case of intoxication the following measures should be taken:
- gastric lavage and reduction of absorption (e.g. activated charcoal)
- local administration of pilocarpine to glaucoma patients
- catheterisation in patients with urinary retention
- treatment with a parasympathomimetic agent (e.g. neostigmine) in the case of severe symptoms
- administration of beta blockers in the case of insufficient response, pronounced tachycardia and/or circulatory instability (e.g. initially 1 mg propranolol intravenously along with monitoring of ECG and blood pressure).
Uraplex is contraindicated in patients with urinary retention, severe gastro-intestinal condition (including toxic megacolon), myasthenia gravis, narrow-angle glaucoma, and tachyarrhythmia.
Uraplex is also contraindicated in patients who have demonstrated hypersensitivity to the active substance or to any of the excipients.
Not applicable
| Tablet core: | Wheat starch Microcrystalline cellulose Lactose monohydrate Povidone Croscarmellose sodium Stearic acid Silica colloidal anhydrous Talc |
| Tablet coat: | Sucrose Carmellose sodium Talc Silica colloidal anhydrous Calcium carbonate E 170 Macrogol 8000 Titanium dioxide E 171 Iron oxide hydrate yellow E 172 Beeswax white Carnauba wax |
Note for diabetics: one coated tablet corresponds to 0.06 g carbohydrate (equivalent to 0.005 bread units
Coated tablet.
Brownish-yellow, glossy coated, biconvex tablets.
Undesirable effects observed with trospium chloride such as dry mouth, dyspepsia and constipation mainly reflect the typical anticholinergic properties of the active ingredient.
In clinical studies, dry mouth was very common and occurred in approximately 18% of patients treated with trospium chloride and in approximately 6% treated with placebo (total of 1931 patients of which 911 received placebo).
The following table lists possibly related drug reactions reported for patients treated with trospium chloride:
|
Very common (>1/10) |
Common (>1/100,<1/10) |
Uncommon (>1/1000, <1/100) |
Rare (>1/10.000, <1/1000) |
Very Rare (<1/10.000) |
Not known (cannot be estimated from the available data) | |
|
Cardiac disorders |
Tachycardia |
Tachyarrhythmia | ||||
|
Nervous system disorders |
Headache |
Dizziness | ||||
|
Eye disorders |
Vision disorders | |||||
|
Respiratory, thoracic and mediastinal disorders |
Dyspnoea | |||||
|
Gastrointestinal disorders |
Dry mouth |
Dyspepsia Constipation Abdominal pain Nausea |
Flatulence Diarrhoea | |||
|
Renal and urinary disorders |
Micturition disorders Urinary retention | |||||
|
Skin and subcutaneous disorders |
Rash |
Angio-oedema |
Pruritus Urticaria Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN) | |||
|
Muscoskeletal and connective tissue disorders |
Myalgia Arthralgia | |||||
|
General disorders and administration site conditions |
Chest pain |
Asthenia | ||||
|
Immune system disorders |
Anaphylaxis | |||||
|
Investigations |
Mild to moderate increase in serum transaminase levels |
Preclinical data reveal no special hazard to humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenicity, and toxicity to reproduction.
Placental transfer and passage of trospium chloride into the maternal milk occurs in rats.
Symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder (e.g. idiopathic or neurologic detrusor overactivity).
Pharmacotherapeutic group: Urinary Antispasmodic, ATC code G04BD09
Trospium chloride is a quaternary derivative of nortropane and therefore belongs to the class of parasympatholytic or anticholinergic drugs, as it competes concentration-dependently with acetylcholine, the body's endogenous transmitter at postsynaptic, parasympathic binding sites.
Trospium chloride binds with high affinity to muscarinic receptors of the so called M1-, M2- and M3- subtypes and demonstrates negligible affinity to nicotinic receptors.
Consequently, the anticholinercic effect of trospium chloride exerts a relaxing action on smooth muscle tissue and organ functions mediated by muscarinic receptors. Both in preclinical as well as in clinical experiments, trospium chloride diminishes the contractile tone of smooth muscle in the gastrointestinal and genito-urinary tract.
Furthermore, it can inhibit the secretion of bronchial mucus, saliva, sweat and the occular accommodation. No effects on the central nervous system have so far been observed.
In two specific safety studies in healthy volunteers trospium chloride has been proven not to affect cardiac repolarisation, but has been shown to have a consistent and dose dependant heart rate accelerating effect.
A long term clinical trial with trospium chloride 20 mg bid found an increase of QT> 60 ms in 1.5% (3/197) of included patients. The clinical relevance of these findings has not been established.
Routine safety monitoring in two other placebo-controlled clinical trials of three months duration does not support such an influence of trospium chloride: In the first study an increase of QTcF >= 60 msec was seen in 4/258 (1.6%) in trospium-treated patients vs. 9/256 (3.5%) in placebo-treated patients. Corresponding figures in the second trial were 8/326 (2.5%) in trospium-treated patients vs. 8/325 (2.5%) in placebo-treated patients.
After oral administration of trospium chloride maximum plasma levels are reached at 4-6 hours. Following a single dose of 20 mg the maximum plasma level is about 4 ng/ml. Within the tested interval, 20 to 60 mg as a single dose, the plasma levels are proportional to the administered dose. The absolute bioavailability of a single oral dose of 20 mg of trospium chloride is 9.6 ± 4.5% (mean value ± standard deviation). At steady state the intraindividual variability is 16%, the interindividual variability is 36%.
Simultaneous intake of food, especially high fat diets, reduces the bioavailability of trospium chloride. After a high-fat meal mean Cmax and AUC are reduced to 15-20% of the values in the fasted state.
Trospium chloride exhibits diurnal variability in exposure with a decrease of both Cmax and AUC for evening relative to morning doses.
Most of the systemically available trospium chloride is excreted unchanged by the kidneys, though a small portion (10% of the renal excretion) appears in the urine as the spiroalcohol, a metabolite formed by ester hydrolysis. The terminal elimination half-life is in the range of 10-20 hours. No accumulation occurs. The plasma protein binding is 50-80%.
Pharmacokinetic data in elderly patients suggests no major differences. There are also no gender differences.
In a study in patients with severe renal impairment (creatinine clearance 8-32 mL/min) mean AUC was 4-fold higher, Cmax was 2-fold higher and the mean half-life was prolonged 2-fold compared with healthy subjects.
Pharmacokinetic results of a study with mild and moderate hepatically impaired patients do not suggest a need for dose adjustment in patients with hepatic impairment, and are consistent with the limited role of hepatic metabolism in the elimination of trospium chloride.
May 2016
Uraplex 20mg Coated Tablets
Meda Pharmaceuticals Ltd
Skyway House
Parsonage Road
Takeley
Bishop's Stortford
CM22 6PU
United Kingdom
This medicinal product does not require any special storage conditions.
PVC foiled aluminium blister
Pack sizes approved: 2, 20, 28, 30, 40, 50, 56, 60, 90, 100, 120, 150, 200, 500, 600, 1000, 1200, 2000
Not all pack sizes may be marketed.
PL 15142/0287
The active ingredient is trospium chloride. Each coated tablet contains 20 mg trospium chloride.
Uraplex should be used with caution by patients:
- with obstructive conditions of the gastrointestinal tract such as pyloric stenosis
- with obstruction of urinary flow with the risk of formation of urinary retention with autonomic neuropathy
- with hiatus hernia associated with reflux oesophagitis
- in whom fast heart rates are undesirable e.g. those with hyperthyroidism, coronary artery disease and congestive heart failure.
As there are no data in patients with severe hepatic impairment, treatment of these patients with Uraplex is not recommended. In patients with mild to moderate liver impairment caution should be exercised.
Trospium chloride is mainly eliminated by renal excretion. Marked elevations in the plasma levels have been observed in patients with severe renal impairment. Therefore in this population and also in patients with mild to moderate renal impairment caution should be exercised.
Before commencing therapy organic causes of urinary frequency, urgency, and urge incontinence, such as heart diseases, diseases of the kidneys, polydipsia, or infections, or tumours of urinary organs should be excluded.
Uraplex 20mg Coated Tablets contain lactose-monohydrate, sucrose and wheat starch.
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Patients with rare hereditary problems of fructose intolerance or sucrase-isomaltase insufficiency should not take this medicine.
Patients with wheat allergy (different from coeliac disease) should not take this medicine. Apart from that, trospium chloride is suitable for people with coeliac disease.
Principally, disorders of accommodation can lower the ability to drive and to use machines.
However, examinations of parameters characterising the ability to drive (visual orientation, general ability to react, reaction under stress, concentration and motor coordination) have not revealed any effects of trospium chloride.
For oral administration.
One coated tablet twice daily (equivalent to 40 mg of trospium chloride per day).
In patients with severe renal impairment (creatinine clearance between 10 and 30 mL/min/1.73 m2) the recommended dosage is one coated tablet per day or every second day (equivalent to 20 mg of trospium chloride per day or every second day).
The coated tablet should be swallowed whole with a glass of water before meals on an empty stomach.
The need for continued treatment should be reassessed at regular intervals of 3-6 months.
Since no data are available, the use in children under 12 years of age is contraindicated.
No special requirements.
Any unused product or waste material should be disposed of in accordance with local requirements.
14/03/2011
