Propiverine

Muscarinic blocker with additional calcium channel blockade

ATC code: G04BD06

Brand names: Mictonorm, Detrunorm

Updated 24 Sep 2026 · Methodology

Indications

Neurogenic detrusor overactivity

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.

Sources

ICD-10: N31.1 · ICD-11: GC01.4

Overactive bladder

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.

Sources

ICD-10: N32.8 · ICD-11: GC50.0

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Frequent urination without prior evaluation

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.

Sources

ICD-10: R35 · ICD-11: MF50.0

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

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.

Safety

Contraindications

Hypersensitivity to propiverine
Urinary retention
Gastric retention
Uncontrolled narrow-angle glaucoma
Myasthenia gravis
Tachyarrhythmias
Toxic megacolon and severe ulcerative colitis

Serious adverse effects

Acute urinary retention
Tachycardia and palpitations
Cognitive impairment in older patients
Acute angle-closure glaucoma
Hepatotoxicity (rare)

Common adverse effects

Dry mouth (15–20%)
Constipation (5–10%)
Dry eyes and blurred near vision
Headache
Somnolence
Fatigue

Pregnancy: can you take Propiverine?

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.

Breastfeeding: can you take Propiverine?

No human lactation data. AEMPS advises discontinuing either the drug or breastfeeding. Lactation-compatible antimuscarinics: oxybutynin or trospium.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Label mentions12 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

antidepresivos tricíclicosclass named in the label
«Incremento del efecto debido a tratamiento concomitante con antidepresivos tricíclicos (ej. imipramina), tranquilizantes (ej. benzodiacepinas), anticolinérgicos (si se administran vía sistémica)…»
AEMPS, section 4.5 · Open on CIMA
antifúngicos azólicosclass named in the label
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
antipsicóticosclass named in the label
«Incremento del efecto debido a tratamiento concomitante con antidepresivos tricíclicos (ej. imipramina), tranquilizantes (ej. benzodiacepinas), anticolinérgicos (si se administran vía sistémica)…»
AEMPS, section 4.5 · Open on CIMA
benzodiazepinasclass named in the label
«Incremento del efecto debido a tratamiento concomitante con antidepresivos tricíclicos (ej. imipramina), tranquilizantes (ej. benzodiacepinas), anticolinérgicos (si se administran vía sistémica)…»
AEMPS, section 4.5 · Open on CIMA
Clarithromycin
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
Erythromycin
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
inhibidores del CYP3A4class named in the label
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
Itraconazole
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
Ketoconazole
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
macrólidosclass named in the label
«Pueden observarse interacciones con otros fármacos que se metabolizan a través del citocromo P4503A4 (CYP 3A4). No obstante, no se espera un incremento significativo en las concentraciones de estos…»
AEMPS, section 4.5 · Open on CIMA
Metoclopramide
«Puede reducirse el efecto de procinéticos como la metoclopramida.»
AEMPS, section 4.5 · Open on CIMA
simpaticomiméticosclass named in the label
«Incremento del efecto debido a tratamiento concomitante con antidepresivos tricíclicos (ej. imipramina), tranquilizantes (ej. benzodiacepinas), anticolinérgicos (si se administran vía sistémica)…»
AEMPS, section 4.5 · Open on CIMA

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Propiverine used for?

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.

What are the side effects of Propiverine?

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.

Is Propiverine safe during pregnancy?

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.

Is Propiverine compatible with breastfeeding?

No human lactation data. AEMPS advises discontinuing either the drug or breastfeeding. Lactation-compatible antimuscarinics: oxybutynin or trospium.

Who should not take Propiverine?

Propiverine is contraindicated in: Hypersensitivity to propiverine; Urinary retention; Gastric retention; Uncontrolled narrow-angle glaucoma; Myasthenia gravis. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMALabel dated 05/09/2023

Other drugs in this group

Pumpkin seed extract, Pygeum africanum, Sildenafil, Silodosin, Tadalafil, Trospium, Dutasteride + Tamsulosin, Solifenacin