Xanomeline-Trospium in Schizophrenia Resource Center
Xanomeline-trospium is the first muscarinic-based therapy approved by the FDA for schizophrenia. It combines M1 and M4 receptor agonism with peripheral muscarinic antagonism from trospium, which does not cross the blood-brain barrier. It was studied as monotherapy in the EMERGENT program and is dosed twice daily on an empty stomach.
This resource center collects the peer-reviewed publications on the subject alongside the companion material built from them: editorial articles on initiation, inpatient use and switching; a clinical pearl covering the Phase 4 SWITCH trial; the foundational papers as published abstracts; and expert video and webinar content.
Consensus Panel Report
Real-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel ReportEditorial Article
Mechanism of Action and the EMERGENT Trial Program
M1 and M4 receptor agonism and the dopamine pathways involved, followed by pooled efficacy and safety results from EMERGENT-1, -2 and -3 and the 52-week open-label extensions.
Editorial Article
Outpatient Initiation and Titration
The panel's three-step outpatient schedule from 50/20 mg twice daily, the follow-up intervals, the fasting requirement, and the anticholinergic agents they monitor for.
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Editorial Article
Inpatient Initiation and Rapid Titration
Escalation to 100/20 or 125/30 mg by day 2 or 3, a retrospective analysis of 49 hospitalized patients, combination use with atypical antipsychotics, and discharge planning.
Editorial Article
Switching and Cross-Titration by Antipsychotic Class
Taper timelines for the -dones, -pines and -azoles, combination use with atypical antipsychotics, and long-acting injectable considerations.
Clinical Pearls
Switching From Oral Atypical Antipsychotics to Xanomeline-Trospium
The Phase 4 SWITCH trial: 105 clinically stable outpatients randomized to a 2-week or 4-week taper of their prior antipsychotic, with 8-week discontinuation, PANSS change and adverse events, alongside the expert panel's taper recommendations by drug class.
Original Research
Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics
Correll et al. · Schizophrenia, 2022
Original Research
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia
Keepers et al. · The American Journal of Psychiatry, 2020
Original Research
The evidence for illness progression after relapse in schizophrenia
Emsley et al. · Schizophrenia Research, 2013
Expert Video
TMS for Depression: Response Rates, Protocols, and the SAINT Question
Transcranial magnetic stimulation for major depressive disorder: response and remission rates including the NeuroStar Outcomes Registry, candidacy and contraindications, 10 Hz rTMS and intermittent theta burst protocols, and the SAINT protocol and its fMRI-guided targeting.
Expert Reel 9:16
COMP360 Psilocybin in Chronic Suicidal Ideation: Reported MSSI Outcomes
A two-speaker cut covering the design of an open-label COMP360 psilocybin trial in chronic suicidal ideation and the reported MSSI change and effect sizes at weeks 1, 3 and 12.
Expert Reel 9:16
TMS Response Rates in Depression
A 9:16 cut covering the reported response rate to TMS in depression and how response is defined on the PHQ-9 and MADRS.
Webinar
A Novel Psychedelic-Based Therapeutic for Postpartum Depression: Phase 2a Results of Inhaled Mebufotenin (GH001)
Kristina Deligiannidis presents a Phase 2a single-arm, open-label trial of inhaled mebufotenin in 10 women with postpartum depression: MADRS and maternal functioning outcomes, breast milk pharmacokinetics, safety, and the stated limitations, followed by audience Q and A.