Muscarinic blocker with additional calcium channel blockade
ATC code: G04BD06 (Propiverine)
Brand names
Mictonorm, Detrunorm
Dual action: 1) competitive blockade of detrusor muscarinic receptors (postsynaptic M3); 2) inhibition of bladder smooth muscle Ca²⁺ channels via the active N-oxide metabolite. This distinguishes it from pure antimuscarinic agents and produces stronger reduction in involuntary detrusor contraction amplitude. Bioavailability around 40%, half-life 14–22 hours, CYP3A4-metabolised. Used in neurogenic detrusor overactivity (multiple sclerosis, spinal cord injury) where pure antimuscarinics are less effective.
First line
Propiverine is indicated for neurogenic detrusor overactivity in adults and in children over 5 years (multiple sclerosis, spinal cord injury, spina bifida, cerebral palsy). EAU Neuro-Urology Guidelines 2024 note propiverine's advantage over pure antimuscarinics due to its additional calcium-blocking activity. Use requires regular bladder ultrasound and post-void residual monitoring; with residual over 100 mL, add clean intermittent catheterisation.
Second line
Propiverine is a second-line muscarinic blocker for overactive bladder. AEMPS approves it in adults and children over 5 years. NG123 (2024) and EAU 2024 place behavioural therapy first; propiverine is added if symptoms persist. Starting dose 15 mg twice daily (or 30 mg SR once daily), up to 45 mg/day if needed. The Madersbacher meta-analysis (2014) showed propiverine has efficacy comparable to oxybutynin with less dry mouth.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Propiverine is marketed as a drug for «frequent toilet visits» without proper diagnostic workup. Increased urinary frequency is a symptom that may mean UTI, diabetes mellitus, BPH, neurological disease, or excess caffeine and fluid intake. Before any muscarinic blocker, the patient needs a bladder ultrasound with post-void residual, urinalysis and a 3-day voiding diary. In men over 50 with untreated BPH, the drug raises the risk of acute urinary retention. If propiverine was prescribed without a bladder ultrasound or urinalysis, consider seeking a second opinion.
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Limited human pregnancy data. AEMPS does not recommend use in pregnancy unless the expected benefit outweighs the risk. Effective contraception is reasonable in women of reproductive age on therapy.
No human lactation data. AEMPS advises discontinuing either the drug or breastfeeding. Lactation-compatible antimuscarinics: oxybutynin or trospium.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Propiverine is evaluated for the following indications with varying evidence strength: Overactive bladder (evidence tier B), Neurogenic detrusor overactivity (evidence tier B), Frequent urination without prior evaluation (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Propiverine (≥ 1 in 100): Dry mouth (15–20%), Constipation (5–10%), Dry eyes and blurred near vision, Headache, Somnolence, Fatigue. See the Safety section for uncommon and serious reactions.
FDA category C. Limited human pregnancy data. AEMPS does not recommend use in pregnancy unless the expected benefit outweighs the risk. Effective contraception is reasonable in women of reproductive age on therapy.
No human lactation data. AEMPS advises discontinuing either the drug or breastfeeding. Lactation-compatible antimuscarinics: oxybutynin or trospium.
Propiverine is contraindicated in: Hypersensitivity to propiverine; Urinary retention; Gastric retention; Uncontrolled narrow-angle glaucoma; Myasthenia gravis. Full list in the Safety section.