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Xanomeline/Trospium Chloride

Phase 4

Alzheimer Disease | Small molecule | Neurology |Bristol-Myers Squibb Company|Trials Updated: Oct 15, 2026

Xanomeline/Trospium Chloride development status

Highest phase Phase 4 (NCT07257120)
Phase scored for BMYPhase 3
Registered trials 27 across 2 sponsors since Aug 2022

Xanomeline/Trospium Chloride target and mechanism

Molecular targetCHRM1, CHRM4
Target classAgonist
ModalitySmall molecule

Also known as xanomeline tartrate, xanomeline, KarXT, BMS-986510

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials15
Total Enrollment4,297

FDA Designations

No designations recorded

Xanomeline/Trospium Chloride clinical trials

Xanomeline/Trospium Chloride · 15 trials · 9 indications

Phase 3 12Phase 2 1Phase 1 2
NCT07084831A Study Evaluating the Efficacy of Xanomeline/Trospium (XT) on Cognitive Impairment After 24 and 52 Weeks of Treatment in Adult Participants With SchizophreniaSchizophrenia; Psychosis
NOT YET_RECRUITING171 Analytics
NCT07686263Relapse Prevention Trial Evaluating KarXT Treatment in SchizophreniaSchizophrenia
RECRUITING472 Analytics
NCT07140913A Study to Evaluate the Efficacy and Safety of Adjunctive KarXT for the Treatment of Mania, With or Without Mixed Features, in Participants With Bipolar-I Disorder Taking Lithium, Valproate, or LamotrigineMania
RECRUITING424 Analytics
NCT07011745A Phase 3 Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's DiseaseAlzheimer's Disease
RECRUITING426 Analytics
NCT07011732A Phase 3 Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's Disease (ADAGIO-1)Alzheimer Disease
RECRUITING426 Analytics
NCT05919823A Study to Assess the Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Chinese Adult Subjects With DSM-5 SchizophreniaSchizophrenia
COMPLETED202 Analytics
NCT05304767An Extension Study to Assess Long-Term Safety and Tolerability of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of SchizophreniaSchizophrenia
COMPLETED290 Analytics
NCT05145413A Study to Assess Efficacy and Safety of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of SchizophreniaSchizophrenia
COMPLETED396 Analytics
NCT04820309An Open-label Study to Assess the Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-5)Schizophrenia
COMPLETED566 Analytics
NCT04738123A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-3)Schizophrenia
COMPLETED256 Analytics
PHASE3NOT YET_RECRUITING
A Study Evaluating the Efficacy of Xanomeline/Trospium (XT) on Cognitive Impairment After 24 and 52 Weeks of Treatment in Adult Participants With Schizophrenia
Schizophrenia; PsychosisUnlock trial analytics
PHASE3RECRUITING
Relapse Prevention Trial Evaluating KarXT Treatment in Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3RECRUITING
A Study to Evaluate the Efficacy and Safety of Adjunctive KarXT for the Treatment of Mania, With or Without Mixed Features, in Participants With Bipolar-I Disorder Taking Lithium, Valproate, or Lamotrigine
ManiaUnlock trial analytics
PHASE3RECRUITING
A Phase 3 Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's Disease
Alzheimer's DiseaseUnlock trial analytics
PHASE3RECRUITING
A Phase 3 Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's Disease (ADAGIO-1)
Alzheimer DiseaseUnlock trial analytics
PHASE3COMPLETED
A Study to Assess the Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Chinese Adult Subjects With DSM-5 Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
An Extension Study to Assess Long-Term Safety and Tolerability of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess Efficacy and Safety of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
An Open-label Study to Assess the Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-5)
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-3)
SchizophreniaUnlock trial analytics

Study Endpoints

Primary Endpoints

Change in cognitive performance after 24 weeks of treatment, relative to baseline.
24 weeks

The within-participant change in the Brief Assessment of Cognition in Schizophrenia composite cognitive score from baseline to follow-up after 24 weeks. Higher score means better cognition. There is no max score, as the tests have different scoring methods (number correct, reaction time).

Time From Randomization to the First Relapse Event
Up to approximately Week 43
Change from baseline in Young Mania Rating Scale (YMRS) at Week 5
At Week 5
Change from baseline on the Cohen-Mansfield Agitation Inventory-International Psychogeriatric Association (CMAI-IPA) total score at Week 14
At Week 14
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Scores at Week 5 of the Double-Blind Period
At Baseline and at Week 5 of the Double-Blind Period

PANSS Total Score is a clinical tool used to measure the severity of symptoms in individuals with schizophrenia. It includes 30 items divided into three subscales: Positive Symptoms (e.g., hallucinations, delusions) Negative Symptoms (e.g., social withdrawal, lack of motivation) General Psychopathology (e.g., anxiety, depression) Each item is rated from 1 (absent) to 7 (extreme), resulting in a total score range from 30 to 210. Higher PANSS Total Scores indicate more severe symptoms and worse clinical outcomes. Baseline is defined as last non-missing assessment prior to the first dose of study drug.

Incidence of treatment-emergent adverse events (TEAEs)
From initial dose to safety follow-up visit (54 weeks) or early termination
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 6
Baseline to Week 6

PANSS Total Score is a clinician administered measure of schizophrenia symptom severity used widely in antipsychotic research. It includes 30 items across 3 subscales: * Positive Symptoms (7 items) assessing excesses or distortions such as hallucinations, delusions, or grandiosity * Negative Symptoms (7 items) assessing diminished function such as social withdrawal or reduced motivation and * General Psychopathology (16 items) capturing broader symptoms like anxiety, depression, guilt, or cognitive impairment Each item is scored from 1 (absent) to 7 (extreme), producing a PANSS Total Score ranging from 30 to 210, with higher scores indicating more severe symptoms. Baseline is defined as the last non missing PANSS Total Score before first dose. This endpoint evaluates change from Baseline to Week 6, with negative values indicating improvement.

Number of Participants With Treatment Emergent Adverse Events (TEAEs)
From time of consent to end of study (approximately 400 days)

TEAEs are defined as events with an onset date on or after the first dose of KarXT. An Adverse Event is any symptom, physical sign, syndrome, or disease that either emerges during the study or, if present at baseline, worsens during the study, regardless of the suspected cause of the event using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 5.0.

Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 5
From baseline up to Week 5

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of participants with schizophrenia and is widely used in the study of antipsychotic therapy. The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. Participants are rated from 1 to 7 on each symptom scale. The positive symptoms in schizophrenia are the excess or distortion of normal function such as hallucinations, delusions, grandiosity, and hostility, and the negative symptoms in schizophrenia are the diminution or loss of normal functions. PANSS total score is the sum of all 30 items with a minimum score of 30 and a maximum score of 210. Higher scores indicate more severe symptoms. The PANSS Total Score is then the sum of the positive, negative, and general psychopathology symptom scores. Baseline is defined as the PANSS score at screening.

Number of Participants With Treatment-Emergent Adverse Events (TEAEs)
From first dose to end of study (Up to approximately 53 weeks)

TEAEs are defined as events with an onset date on or after the first dose of KarXT. An Adverse Event is any symptom, physical sign, syndrome, or disease that either emerges during the study or, if present at baseline, worsens during the study, regardless of the suspected cause of the event using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 5.0.

[18F]DOPA Kicer ([18F]DOPA relative uptake rate)
Pre/post 5 weeks of Xanomeline and trospium chloride (KarXT)
Mean weekly maximum composite Visual Analogue Scale (VAS) score (nausea, diarrhea, sweating, salivation and vomiting combined) comparing xanomeline + placebo to xanomeline + trospium
7 days

Secondary Endpoints

Change in negative symptoms after 24 weeks of treatment, relative to baseline.
24 weeks
Time to Discontinuation During Double-blind Treatment Period
Approximately From Week 18 to 43
Number of Participants With Treatment Emergent Adverse Events (TEAEs)
Up to approximately Week 45
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Study Design & Arms

AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Xanomeline/trospiumEXPERIMENTALXanomeline/trospium that is provided to all participants
KarXTEXPERIMENTAL -
PlaceboPLACEBO_COMPARATOR -
KarXT + Lithium, Valproate, or LamotrigineEXPERIMENTAL -
Placebo + Lithium, Valproate, or LamotriginePLACEBO_COMPARATOR -
KarXT + KarX-ECEXPERIMENTAL -
Drug: KarXTEXPERIMENTAL -
Xanomeline 50 mg and trospium chloride 20mg (KarXT)EXPERIMENTAL5 weeks of xanomeline 50mg/trospium 20mg bid (low dose arm).
Xanomeline 100 mg and trospium chloride 20mg (KarXT)EXPERIMENTAL5 weeks of xanomeline 100mg/trospium 20mg bid (middle dose arm).
Xanomeline 125 mg and trospium chloride 30mg (KarXT)EXPERIMENTAL5 weeks of xanomeline 125mg/trospium 30mg bid (high dose arm).
Xanomeline plus placeboACTIVE_COMPARATORDrug: Xanomeline tartrate 75 mg TID, for 225 mg total daily dose Placebo, TID
Xanomeline plus trospiumEXPERIMENTALDrug: Xanomeline tartrate 75 mg TID, for 225 mg total daily dose Drug: Trospium chloride 20 mg BID, for a 40 mg total daily dose

Interventions

NameTypeDescription
Xanomeline/trospiumDRUGParticipants will receive oral xanomeline/trospium during the trial (target dose 125/30 BID).
Xanomeline/Trospium ChlorideDRUGSpecified dose on specified days
PlaceboDRUGSpecified dose on specified days
Xanomeline/Trospium Chloride CapsuleDRUGSpecified dose on specified days
Xanomeline Enteric CapsuleDRUGSpecified dose on specified days
Xanomeline and Trospium Chloride CapsulesDRUGOral xanomeline 50 mg/trospium 20 mg BID on days 1-2 followed by xanomeline 100 mg/trospium 20 mg BID on days 3-7. The dose is increased to xanomeline 125 mg/trospium 30 mg BID on days 8-35 unless the subject is experiencing adverse events from the xanomeline 100 mg/ trospium 20 mg dose. Subjects who were increased to xanomeline 125 mg/trospium 30 mg will have the option to return to xanomeline 100 mg/ trospium 20 mg depending on clinical response and tolerability.
Placebo CapsulesDRUGPlacebo Capsules
Xanomeline and trospium chloride (KarXT)DRUGSubjects will be randomized to 5 weeks of low, middle, or high dose of Xanomeline and trospium chloride, and will complete a PET scan with \[18\]F DOPA at the beginning and end of the treatment period.
xanomeline tartrateDRUGxanomeline tartrate, 75 mg capsule, TID
Trospium chlorideDRUGtrospium chloride, over encapsulated 20 mg tablet, BID
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Eligibility Criteria

Age Range18 Years to 55 Years
SexALL
Healthy VolunteersNo
Study Sites16

Inclusion criteria: 1. Be between 18 and 55 years of age. 2. Be willing and able to provide informed consent, after the nature of the study has been fully explained. This includes being able to understand the locally approved informed consent (and information letter) in the local language. 3. Have ...

Countries:AustriaBelgiumCzechiaDenmarkGermanyHungaryIsraelItalyNetherlandsSpainUnited StatesArgentinaBulgariaPolandRomaniaUnited KingdomChinaFranceIndiaJapanUkraineChilePuerto RicoSouth KoreaBrazilCanadaCroatiaGreeceMexicoPortugalTaiwanSerbia
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Recent Changes (Last 90 Days)

LOWOct 15, 2026NCT07011732lastUpdatePostDate: changed
LOWOct 15, 2026NCT07011732lastUpdatePostDate: changed
LOWOct 8, 2026NCT07011745lastUpdatePostDate: changed
LOWOct 8, 2026NCT07011745lastUpdatePostDate: changed
LOWSep 28, 2026NCT07686263lastUpdatePostDate: changed
LOWSep 28, 2026NCT07686263lastUpdatePostDate: changed
LOWSep 16, 2026NCT07011732lastUpdatePostDate: changed
LOWSep 16, 2026NCT07011745lastUpdatePostDate: changed
LOWSep 16, 2026NCT07011732lastUpdatePostDate: changed
LOWSep 16, 2026NCT07011745lastUpdatePostDate: changed
LOWSep 15, 2026NCT07686263Status: NOT_YET_RECRUITING → RECRUITING
LOWSep 15, 2026NCT07686263Status: NOT_YET_RECRUITING → RECRUITING
LOWSep 15, 2026NCT07686263Status: NOT_YET_RECRUITING → RECRUITING
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
LOWAug 26, 2026NCT07011745lastUpdatePostDate: changed
LOWAug 26, 2026NCT07011745lastUpdatePostDate: changed
LOWAug 11, 2026NCT07011732lastUpdatePostDate: changed

Frequently asked questions about Xanomeline/Trospium Chloride

What is Xanomeline/Trospium Chloride?

Xanomeline/Trospium Chloride is an investigational small molecule drug candidate being developed by Bristol-Myers Squibb Company (ticker: BMY) for neurological and psychiatric conditions. It is a fixed combination of xanomeline tartrate and trospium chloride, and it is currently in Phase 3 clinical development. It is not yet approved for any indication.

What is Xanomeline/Trospium Chloride used for?

Xanomeline/Trospium Chloride is being studied for the treatment of schizophrenia, psychosis, mania in bipolar I disorder, and Alzheimer disease. Clinical trials have enrolled participants with schizophrenia, schizoaffective disorder, and bipolar I disorder with mania, with or without mixed features. It remains investigational and has not been approved for any use.

What does Xanomeline/Trospium Chloride target?

Xanomeline/Trospium Chloride targets the muscarinic acetylcholine receptors CHRM1 and CHRM4 as an agonist. Xanomeline is the active muscarinic agonist component, while trospium chloride is included to limit peripheral muscarinic side effects. This dual-target agonist approach distinguishes it from dopamine-based antipsychotic mechanisms.

Who makes Xanomeline/Trospium Chloride?

Xanomeline/Trospium Chloride is being developed by Bristol-Myers Squibb Company, which trades under the ticker BMY. Bristol-Myers Squibb is the sponsor of the clinical development program, which includes Phase 3 trials in schizophrenia and bipolar mania, as well as a Phase 1 PET/MRI study.

What phase is Xanomeline/Trospium Chloride in?

Xanomeline/Trospium Chloride is in Phase 3 clinical development. It is an investigational drug and has not been approved by the FDA or any regulatory agency. The program includes multiple Phase 3 trials, with 10 total trials reported, of which 9 are completed and 2 are currently active.

What clinical trials is Xanomeline/Trospium Chloride in?

Xanomeline/Trospium Chloride is being evaluated in several clinical trials, including NCT07686263, a Phase 3 relapse prevention study in schizophrenia; NCT07140913, a Phase 3 adjunctive trial in bipolar I mania; NCT07084831, a Phase 3 cognitive impairment study in schizophrenia; and NCT07423546, a Phase 1 PET/MRI study of dopamine transmission.

Is Xanomeline/Trospium Chloride the same as KarXT?

Yes, Xanomeline/Trospium Chloride is also known as KarXT, as well as xanomeline tartrate, xanomeline, and Xanomeline and Trospium Chloride Capsules. These names refer to the same investigational fixed-dose combination developed by Bristol-Myers Squibb. The abbreviation XT is also used in some trial titles.