Xanomeline-trospium is a muscarinic agonist, and the trospium is there only to block the peripheral muscarinic effects. A lot of people are trying it as a second antipsychotic because its mechanism is totally different, but when it is tolerated we do not see it make much of a dent, and when it does make a minor dent it is completely intolerable.
In practice
A lot of people are trying it as a second antipsychotic because its mechanism is totally different. When it is tolerated, we do not see it making much of a dent, and when it does make a minor dent, it is completely intolerable.
“A lot of people are trying to use it kind of as a second antipsychotic because it's got a totally different mechanism. First of all, when it's tolerated, I don't see it really making much of a dent. And second of all, when it's making a minor dent, it's completely intolerable”
1:02:50Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
How it works
It is a muscarinic agonist: xanomeline activates M1 and M4 receptors. Trospium is not there for the symptoms; it just blocks the peripheral muscarinic effects so that, in theory, there are fewer problems.
“it's a muscarinic agonist. So it's an M1 and M4 receptors. The xanamaline activates the M1, M4. The trospium is not for the symptoms. So it just blocks the peripheral muscarinic effects so that theoretically there's less problems”
1:03:39Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
From these episodes
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Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.