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Xanomeline/Trospium Combination for Schizophrenia: Treatment Considerations for Older Adults
Purpose:
Xanomeline/trospium, a combination of a mixed muscarinic agonist/peripheral antagonist, is a novel treatment for schizophrenia that does not antagonize dopamine receptors. Given its unique pharmacology on the cholinergic system, special considerations may apply for older adults.
Method:
The current article reviews the evidence of xanomeline/trospium in older adults as well as implications and considerations for use in practice.
Results:
The evidence of using xanomeline/trospium is largely derived from the phase-3 EMERGENT clinical trial program, which investigated safety and efficacy in adults aged 18 to 65 years with schizophrenia. Significant reduction in psychosis was demonstrated; however, gastrointestinal effects were common.
Conclusion:
Xanomeline/trospium is a novel treatment for schizophrenia that lacks many of the adverse effects associated with dopamine receptor blockers. Although the package insert provides guidance for use in older adults, patients aged >65 years were excluded from EMERGENT trials. Continued research is necessary to define the safety and place in therapy for older adults. [Journal of Gerontological Nursing, 51(6), 7-12.].
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