[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Muscarinic antipsychotics](https://durgical.com/en/pharmacology/classes/muscarinic-antipsychotics/) › Xanomeline and trospium

# Xanomeline and trospium

## Muscarinic antipsychotics?

Muscarinic antipsychotics

A schizophrenia treatment that stimulates brain M1/M4 muscarinic receptors (xanomeline) while trospium blocks muscarinic effects in the body.

Updated Nov 1, 2026

## Quick facts

**Group**
[Muscarinic antipsychotics](https://durgical.com/en/pharmacology/classes/muscarinic-antipsychotics/)

**Target**
Muscarinic M4 and M1 receptors (xanomeline, agonist); M4 shown

**Used for**
Schizophrenia in adults

**Key effects**
Nausea · Constipation or diarrhoea · Dry mouth

**Monitor**
Liver tests · Urination and bowel habit · Heart rate

**ATC**
N05AX50

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Muscarinic M4 and M1 receptors (xanomeline, agonist); M4 shown**Xanomeline and trospium

ⓘ The figure shows xanomeline bound to the human M4 muscarinic receptor with its Gi protein. Trospium, the second component, is not in the structure.

**Target in 3D:** Muscarinic M4 and M1 receptors (xanomeline, agonist); M4 shown. PDB structure 8FX5 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8FX5) · Drag to rotate · pinch to zoom

Xanomeline is a muscarinic agonist that prefers M1 and M4 receptors and acts in the brain. M4 agonism is thought to be an antipsychotic mechanism (mice lacking M4 show a psychosis-like phenotype), and it works without blocking D2 receptors. Trospium is a quaternary antimuscarinic that hardly crosses the blood-brain barrier; it is added to limit the cholinergic effects of xanomeline in the rest of the body.

- Xanomeline stimulates brain M1 and M4 receptors
- M4 agonism is thought to calm psychosis
- Trospium blocks muscarinic receptors outside the brain
- No D2 block: little parkinsonism or prolactin rise

## Indications

- Schizophrenia in adults [Schizophrenia →](https://durgical.com/en/conditions/schizophrenia/)

## Adverse effects

### Common

- Nausea, vomiting, heartburn and abdominal pain
- Constipation or diarrhoea
- Dry mouth, blurred vision
- Fast heart rate, dizziness, sleepiness

### Serious (rare, important)

- Urinary retention
- Liver injury: jaundice, dark urine
- Angioedema of the face, lips or throat
- Confusion and hallucinations, more likely in older people

## Contraindications

- Urinary retention or bladder outflow obstruction
- Gastric retention
- Untreated narrow-angle glaucoma
- Liver disease
- Hypersensitivity to xanomeline or trospium

## Key interactions

**Other anticholinergic drugs**
More dry mouth, constipation, urinary retention and confusion

**Alcohol**
Worse side effects such as dizziness and sleepiness

## What is monitored

- Liver tests
- Urination and bowel habit
- Heart rate
- Psychotic symptoms

## Administration and safety

- Capsules are swallowed whole, not opened or chewed
- Given on an empty stomach, apart from meals

## Pregnancy and breastfeeding

Human data are limited; use weighs benefit and risk.

## Nursing care

- Asks about difficulty passing urine, weak stream or incomplete emptying
- Watches for jaundice, dark urine or abdominal pain and reports them
- Records heart rate and asks about nausea and constipation
- Takes extra care in older patients, who are more prone to side effects

## Pharmacokinetics

**Absorption**
By mouth, on an empty stomach (one hour before or two hours after a meal)

**Elimination**
The trospium component is eliminated mainly by the kidneys

## Memory aid

«X in the brain, T at the border»: Xanomeline turns muscarinic receptors on inside the brain; Trospium guards the body outside.

## Test yourself

Think of the answer, then tap the question to see it.

## Which receptors does xanomeline stimulate to treat schizophrenia?

Muscarinic M1 and M4 receptors in the brain.

## Why does trospium not cancel xanomeline's antipsychotic effect?

Trospium is a quaternary amine that barely crosses the blood-brain barrier, so it acts mainly in the periphery.

## Which urinary problem is a warning with this combination?

Urinary retention.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/xanomeline-and-trospium/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 2

- [Trospium](https://durgical.com/en/pharmacology/trospium/)
- [Haloperidol](https://durgical.com/en/pharmacology/haloperidol/)

## Related conditions 1

- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)

[← Back to the class: Muscarinic antipsychotics](https://durgical.com/en/pharmacology/classes/muscarinic-antipsychotics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Xanomeline and trospium chloride: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a624070.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05AX50) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/xanomeline-and-trospium/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/xanomeline-and-trospium/