Trospium chloride is an antimuscarinic agent indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. It has been available in Europe for over 20 years and in the United States since May 2004. Trospium has pharmacologic properties that are distinct from other antimuscarinic agents. The safety and efficacy profiles of trospium and how its pharmacologic properties contribute to these profiles form the basis for this review. The low incidence of adverse event of central nervous system effects and the efficacy parameters of "urgency" and "onset of action" are highlighted.