Cobenfy (xanomeline / trospium) is a prescription medication used to treat schizophrenia in adults. It's a combination of two medications: xanomeline (a muscarinic agonist) and trospium (a muscarinic antagonist). Cobenfy (xanomeline / trospium) works differently from traditional antipsychotic medications because it doesn’t target dopamine receptors. It comes as a capsule you take by mouth twice a day on an empty stomach. Common side effects include nausea, indigestion, constipation, and vomiting.
Schizophrenia in adults
Cobenfy is a combination of two medications, but how it works isn't completely clear.
Xanomeline is a muscarinic agonist. It activates muscarinic receptors in the brain that affect thinking and behavior. This is thought to help reduce symptoms of schizophrenia like hallucinations and delusions.
Trospium is a muscarinic antagonist. It blocks similar receptors outside the brain, which can help reduce side effects like diarrhea, sweating, vomiting, and stomach cramps.
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Works differently from other schizophrenia medications
Lower risk of weight gain compared to older antipsychotics
Less movement-related side effects compared to antipsychotics
Must be taken twice a day on an empty stomach
Commonly causes nausea, constipation, and vomiting
Not recommended for people with certain kidney or liver problems
Take Cobenfy (xanomeline / trospium) twice a day on an empty stomach to help the medication work properly. That means take it at least 1 hour before a meal or 2 hours after eating.
Swallow Cobenfy (xanomeline / trospium) capsules whole. Don't chew, open, or break them. If you're having trouble swallowing pills, talk to your prescriber.
Cobenfy (xanomeline / trospium) commonly causes stomach-related side effects, such as nausea, indigestion, constipation, and vomiting. These are usually mild, but tell your prescriber if they get worse or don’t go away.
Cobenfy (xanomeline / trospium) might affect how you think, focus, and react. You might also feel dizzy or have blurry vision. Don’t drive or use heavy equipment until you know how the medication affects you.
Cobenfy (xanomeline / trospium) can raise your heart rate. Your prescriber might check your heart rate before and during treatment. Tell your care team if you notice a fast or irregular heartbeat.
Cobenfy (xanomeline / trospium) can make it hard to urinate, especially in older adults or people with bladder problems. Watch for signs like weak flow, pain, or not feeling like your bladder is empty. If you can’t urinate at all, get medical help right away.
Some people might have a serious allergic reaction to Cobenfy (xanomeline / trospium). Get help right away if your tongue or throat swells or you have trouble breathing. Stop taking the medication and call your care team immediately if this happens.
Cobenfy (xanomeline / trospium) can interact with many common medications. Tell your care team about everything you're taking, including over-the-counter drugs and supplements. Don’t start anything new without checking with your prescriber or pharmacist first.
Tell your prescriber if you're pregnant or think you might be while taking Cobenfy (xanomeline / trospium). They can help you decide if it's safe to keep taking during pregnancy. If so, you’re encouraged to join the pregnancy registry to help track health outcomes.
Cobenfy (xanomeline / trospium) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Older adults | History of bladder conditions | Enlarged prostate | Moderate-to-severe kidney problems
Cobenfy (xanomeline / trospium) can make it harder for your bladder to empty fully. This might occur at any time during treatment and is more likely with higher doses. It can also raise your risk of a urinary tract infection (UTI). Your risk is higher if you're an older adult or have certain conditions like an enlarged prostate (also called benign prostatic hyperplasia, or BPH).
Watch for signs like trouble starting to urinate, a weak or slow stream, going more often than usual, feeling like your bladder is full but not emptying, or pain when urinating. Tell your prescriber if you notice any of these symptoms. They might lower your dose, stop the medication, or refer you to a specialist. Get medical help immediately if you can’t urinate at all.
If you have liver problems, you might have a higher risk of side effects from Cobenfy (xanomeline / trospium). Tell your prescriber about any liver conditions before starting this medication. They will check your liver with a blood test before treatment and might test while you're taking it. Call your care team if you notice signs of liver problems like yellowing of your skin or eyes, dark urine, stomach pain, itching, nausea, vomiting, loss of appetite, fever, chills, light-colored stools, or feeling very tired.
Cobenfy (xanomeline / trospium) isn't recommended in people with active gallbladder problems like gallstones. Your prescriber will check your liver and bilirubin levels before starting Cobenfy (xanomeline / trospium). Contact your care team if you experience symptoms like upset stomach, nausea, vomiting, or pain in the upper stomach.
Risk factors: Ulcerative colitis | Problems with slow stomach emptying | Myasthenia gravis
Cobenfy (xanomeline / trospium) contains trospium, which can slow down how food moves through your gut. If you have certain stomach or muscle conditions — like ulcerative colitis (UC), myasthenia gravis (MG), or a blockage in your gut — this medication could make your symptoms worse. Tell your prescriber about any digestive or muscle-related health problems before starting Cobenfy (xanomeline / trospium).
Some people who took Cobenfy (xanomeline / trospium) have had a rare but serious side effect called angioedema. This causes swelling in areas like the face, throat, or tongue. Swelling in your throat or tongue can be life-threatening because it can make it hard to breathe. Go to the emergency room right away if you have trouble breathing or sudden swelling around your face or throat.
Cobenfy (xanomeline / trospium) can cause your pupils to get bigger. This can be dangerous if you have a type of eye condition called narrow-angle glaucoma, as it might cause a sudden attack. Tell your prescriber right away if you notice symptoms like red eyes, blurry vision, seeing halos or bright colors around lights, eye pain, nausea or vomiting, or a severe headache.
Cobenfy (xanomeline / trospium) can raise your heart rate. Your prescriber might check your heart rate before you start the medication and during treatment if needed. Let your care team know if you feel a fast or pounding heartbeat while taking this medication.
Cobenfy (xanomeline / trospium) isn't recommended if you have moderate or severe kidney problems because the medication can build up in your body. This can raise the chance of side effects like dry mouth, constipation, indigestion, urinary tract infections (UTIs), or trouble urinating. Talk to your prescriber if you have kidney problems before starting this medication.
Cobenfy (xanomeline / trospium) can cause side effects like sleepiness, dizziness, confusion, and seeing or hearing things that aren’t there (hallucinations). These side effects are more likely to happen when you first start the medication or when your dose changes. Avoid driving or doing anything that needs your full attention until you know how this medication affects you. Let your care team know if you're experiencing any of these side effects, especially if they affect your usual daily activities. They might lower your dose or stop the medication if needed.
The typical starting dose is 50 mg/20 mg (xanomeline/trospium) by mouth twice a day on an empty stomach — 1 hour before or 2 hours after a meal — for at least 2 days. After that, the dose is usually raised to 100 mg/20 mg (xanomeline/trospium) twice a day for at least 5 days. If needed, your prescriber might raise the dose again to 125 mg/30 mg (xanomeline/trospium) twice a day.
The dose might differ for older adults.
Trouble emptying your bladder
Moderate or severe liver problems
Slow emptying of the stomach
Allergy to xanomeline or trospium
Untreated narrow-angle glaucoma
Schizophrenia in adults
Schizophrenia in adults and children age 13 years and older
Bipolar I disorder in adults and children age 13 years and older
Bipolar depression in adults and children age 10 years and older
Depression that hasn't responded well to other treatments
Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old
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