Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antimuscarinic (overactive bladder) Pregnancy: There are no data from the use of propiverine in pregnant women. Studies in animals have shown reproductive toxicity. Propiverine is not recommended during pregnancy. Breast-feeding: it is unknown whether propiverine or metabolites are excreted in human milk. Available pharmacodynamic/toxicological data in animals have shown excretion of propiverine or metabolites in milk. A risk to the newborn or infant cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from propiverine therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. Fertility: there are no human data on the effect of propiverine on fertility; animal studies do not indicate direct or indirect harmful effects with respect to fertility. (UK SPC §4.6)

Propiverine hydrochloride

Brand names: Detrunorm

Propiverine hydrochloride is an antimuscarinic agent used to treat urinary frequency, urgency and urge incontinence associated with overactive bladder and neurogenic detrusor overactivity.

Adult dose

Dose: Overactive bladder syndrome (urinary incontinence and/or increased urinary frequency and urgency): standard dose one 15 mg film-coated tablet (15 mg propiverine hydrochloride) twice daily, which may be increased to three times daily; some patients may already respond to 15 mg daily. Neurogenic detrusor overactivity: one 15 mg film-coated tablet three times daily
Route: Oral
Frequency: Twice daily (may be increased to three times daily); three times daily for neurogenic detrusor overactivity; take before a meal
Max: 45 mg/day
SPC §4.1: 'Symptomatic treatment of urinary incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome or neurogenic detrusor overactivity (detrusor hyperreflexia) from spinal cord injuries, e.g. transverse lesion paraplegia.' §4.2 Adults (verbatim): 'As a standard dose one film-coated tablet (= 15 mg propiverine hydrochloride) twice daily is recommended, this may be increased to three times daily. Some patients may already respond to a dosage of 15 mg daily. For neurogenic detrusor overactivity a dose of one film-coated tablet three times daily is recommended. The maximum recommended daily dose is 45 mg.' Strength (§2): each film-coated tablet contains 15 mg propiverine hydrochloride (equivalent to 13.64 mg propiverine); product is Mictonorm 15 mg coated tablets - this SPC covers the 15 mg film-coated tablet only. Food: 'A high fat meal increases the bioavailability of propiverine. Therefore, propiverine should be taken before a meal, especially in patients with renal or hepatic impairment.' Elderly: 'Generally there is no special dosage regimen for the elderly.' Patients receiving potent flavin-containing monooxygenase (FMO) inhibitors such as methimazole in combination with potent CYP 3A4/5 inhibitors: treatment should start with a dose of 15 mg per day, which may thereafter be titrated to a higher dose, with careful monitoring for side effects. Children: 'Due to a lack of data Mictonorm should not be used in children.' No paediatric dose.

Dose adjustments

Renal

SPC §4.2: mild or moderate renal impairment - no dose adjustment is required; however, treat with caution. Severely impaired renal function (creatinine clearance < 30 ml/min): the maximum daily dose is 30 mg. Take before a meal, especially in renal impairment.

Hepatic

SPC §4.2: mildly impaired hepatic function - no need for dose adjustment; treatment should proceed with caution. No studies in moderate or severe hepatic impairment; use is not recommended in these patients. §4.3: moderate or severe hepatic impairment is a contraindication.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients (§4.3)
  • Obstruction of the bowel (§4.3)
  • Significant degree of bladder outflow obstruction where urinary retention may be anticipated (§4.3)
  • Myasthenia gravis (§4.3)
  • Intestinal atony (§4.3)
  • Severe ulcerative colitis (§4.3)
  • Toxic megacolon (§4.3)
  • Uncontrolled angle closure glaucoma (§4.3)
  • Moderate or severe hepatic impairment (§4.3)
  • Tachyarrhythmias (§4.3)

Side effects

  • Very common: dry mouth (§4.8)
  • Common: headache, accommodation disorder, visual impairment, constipation, abdominal pain, dyspepsia, fatigue (§4.8)
  • Uncommon: tremor, dizziness, dysgeusia, decreased blood pressure with drowsiness, flushing, nausea/vomiting, pruritus, urinary retention, bladder and urethral symptoms (§4.8)
  • Rare: hypersensitivity, tachycardia, rash (§4.8)
  • Very rare: restlessness, confusion, palpitation; frequency not known: hallucination, speech disorder (§4.8)
  • All undesirable effects are transient and recede after a dose reduction or termination of therapy after a maximum of 1-4 days (§4.8)

Interactions

  • Increased effects with tricyclic antidepressants (e.g. imipramine), tranquillisers (e.g. benzodiazepines), systemic anticholinergics, amantadine, neuroleptics (e.g. phenothiazines) and beta-adrenoceptor agonists (beta-sympathomimetics) (§4.5)
  • Decreased effects with cholinergic drugs; the effect of prokinetics such as metoclopramide may be decreased (§4.5)
  • Reduced blood pressure in patients treated with isoniazid (§4.5)
  • Weak inhibitor of CYP 3A4; pharmacokinetic studies with potent CYP 3A4 inhibitors (azole antifungals, macrolide antibiotics) have not been performed (§4.5)
  • Potent FMO inhibitors such as methimazole combined with potent CYP 3A4/5 inhibitors: start at 15 mg per day and monitor carefully for side effects (§4.2, §4.5)

Monitoring

  • During long-term therapy monitor hepatic enzymes, because reversible changes of liver enzymes might occur in rare cases (§4.8)
  • Rule out pollakiuria and nocturia due to renal disease or congestive heart failure, and organic bladder diseases (e.g. urinary tract infections, malignancy), before treatment (§4.4)
  • Use with caution in autonomic neuropathy, renal impairment and hepatic impairment (§4.4)
  • May aggravate severe congestive heart failure (NYHA IV), prostatic enlargement, hiatus hernia with reflux oesophagitis, cardiac arrhythmia and tachycardia (§4.4)
  • Induces mydriasis; risk of acute angle-closure glaucoma in individuals predisposed with narrow angles of the anterior chamber (§4.4)

Clinical monograph

How it works

It combines antimuscarinic blockade of bladder muscarinic receptors with a degree of direct smooth muscle (calcium-modulating) relaxant activity, reducing detrusor overactivity and increasing bladder capacity.

Prescribing in practice

  • It is contraindicated in conditions such as urinary retention, gastric retention, significant gastrointestinal obstruction, angle-closure glaucoma and myasthenia gravis.
  • Use cautiously in older patients and those with autonomic neuropathy, hepatic or renal impairment, or cardiac arrhythmia, with attention to anticholinergic burden.
  • It may impair the ability to drive or operate machinery because of drowsiness and blurred vision.

Monitoring

Review symptom response after an adequate trial and monitor for anticholinergic adverse effects, residual urine volume and cognitive effects in vulnerable patients.

Counselling the patient

  • Be aware of dry mouth, constipation and blurred vision, and report inability to pass urine.
  • Do not drive or use machinery if you feel drowsy or your vision is blurred.

Evidence & guidelines

Antimuscarinics are recommended by NICE for overactive bladder when conservative measures are insufficient; see current guidance for choice and review.

Reference: NICE NG123; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways