xanomeline/trospium

General information

• Class: Antipsychotic
• Common US brands: COBENFY
• Typical dose range: Standard titration: 50/20 mg BID (Days 1-2) → 100/20 mg BID (Days 3-7) → 125/30 mg BID (Day 8 onward). Maximum dose 125/30 mg twice daily.
• Therapeutic drug monitoring not routinely recommended.
• Last reviewed: 2026-03-13

Dosing & forms

• Forms/strengths: Capsules: 50 mg/20 mg, 100 mg/20 mg, and 125 mg/30 mg (xanomeline/trospium chloride). A starter pack containing the titration sequence is available.
• Frequency: Standard titration: 50/20 mg BID (Days 1-2) → 100/20 mg BID (Days 3-7) → 125/30 mg BID (Day 8 onward). Maximum dose 125/30 mg twice daily.
• Food: Take on an empty stomach.
• Typical range: Standard titration: 50/20 mg BID (Days 1-2) → 100/20 mg BID (Days 3-7) → 125/30 mg BID (Day 8 onward). Maximum dose 125/30 mg twice daily.

Mechanism (brief)

First-in-class muscarinic M1/M4 receptor agonist (xanomeline) combined with peripheral muscarinic antagonist (trospium chloride) for schizophrenia; does not block dopamine D2 receptors.

Metabolism & Half‑life

• Metabolism: CYP2D6, CYP2B6, CYP1A2, FMO1, FMO3
• Half‑life: Single-dose mean 5 h; Steady-state mean 5 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

Sources

• COBENFY (xanomeline and trospium chloride) prescribing information — Bristol-Myers Squibb (2024)
• U.S. FDA Approves Bristol Myers Squibb's COBENFY, a First-in-Class Muscarinic Agonist for the Treatment of Schizophrenia in Adults — Bristol-Myers Squibb (2024)
• Efficacy and Safety of Xanomeline-Trospium Chloride in Schizophrenia: Results of the EMERGENT-3 Randomized Clinical Trial — JAMA Psychiatry (2024)
• Efficacy and safety of KarXT (xanomeline-trospium) in schizophrenia (EMERGENT-2): a randomised, double-blind, placebo-controlled, flexible-dose, phase 3 trial — Lancet (2023)
• The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
• Pooled analysis of the EMERGENT program: efficacy and safety of xanomeline-trospium in schizophrenia — Nature Schizophrenia (2024)