Course Summary

Expiration Date: 06/11/2028

Xanomeline–trospium is an FDA-approved oral antipsychotic (approved in 2024) that introduces a novel mechanism for treating schizophrenia by selectively targeting muscarinic M1 and M4 receptors, avoiding dopamine receptor antagonism. This fixed-dose combination pairs centrally acting xanomeline with trospium, a peripherally restricted muscarinic antagonist, to reduce systemic side effects. This course reviews its pharmacology, clinical application, and safety profile, with a focus on its potential use in patients who are intolerant to traditional antipsychotics due to extrapyramidal symptoms, sedation, or metabolic complications. Evidence from the EMERGENT-3, -4, and -5 trials is examined to highlight both short-term efficacy and long-term tolerability. Practical guidance on monitoring, patient selection, and place in therapy is included to support clinical use in psychiatric nursing and advanced practice settings.

Course Format

Homestudy

Course Syllabus

  • Introduction
  • Pharmacological Overview
  • Therapeutic Use in Schizophrenia
  • Use Considerations in Clinical Practice
  • Adverse Effects and Monitoring
    • Introduction:
    • Study Design Highlights:
    • Results:
  • EMERGENT-3: Acute Efficacy and Symptom Improvement Over 5 Weeks
  • Clinical interpretation:
  • EMERGENT-4: Long-Term Effects in Patients Who Continued Treatment
  • Clinical interpretation:
  • EMERGENT-5: One-Year Data in Stable Outpatients Starting Treatment
  • Clinical interpretation:
    • Safety and Tolerability:
    • Strengths of the EMERGENT Program:
    • Limitations:
    • Adjunctive Use in Schizophrenia
    • Clinical Implications and Place in Therapy
  • Summary

Authors

Richard Daniels, PharmD, BCPS

Richard “Cole” Daniels earned his Doctor of Pharmacy(PharmD) from the Skaggs School of Pharmacy at the University of Montana in 2018. Throughout pharmacy school he completed a 3-year internship at Community Medical Center in Missoula, Montana in which he gained valuable experience in an acute care setting. Cole currently serves as a psychiatric clinical staff pharmacist at the Montana State Hospital. He has over 11 years of pharmacy experience having worked in several settings including retail, acute care, and inpatient psychiatric care. Cole has a diverse set of interests. However, acute care medicine, infectious disease, pain management, and asthma/COPD are a primary focus of his at the Montana State Hospital. He obtained board certification as a certified pharmacotherapy specialist in the Spring of 2022.

Elisabeth Gordon, BScPharm, RPh

Elisabeth Gordon earned her BSc(Pharm) from the University of British Columbia in 2004. After graduation, she worked in community retail pharmacies on Vancouver Island, before returning to her rural hometown of Salmon Arm. In 2016 and 2017, Elisabeth trained with Pallium Canada and Victoria Hospice to enhance her knowledge of end-of-life-care and palliative services. She is a volunteer medical supervisor for T1DOutreach, a peer support platform for adults living with type 1 diabetes, and a member of a Canadian peer support group for adults living with Birdshot Uveitis. Elisabeth enjoys working in a small, fast-paced rural pharmacy where she brings compassion and empathy to her everyday practice.