Anticholinergic Drugs

Anticholinergic Drugs

Dr. Kennedy“Anticholinergic” is the word denoting the action of certain medications that inhibit the transmission of parasympathetic nerve impulses (cholinergic) and thereby reduce spasms of smooth muscle (such as that, for example, in the bladder) as well as a range of vegetative (digestive and circulatory) functions. This actions accounts for the side-effects of the anticholinergic drugs.

Here are some common examples of anticholinergic drugs:

  • Aceprometazine — Neuroleptic, antihistamine (phenothiazine)
  • Acepromazine — Neuroleptic (phenothiazine)
  • Alimemazine — Antihistamine, sedative (phenothiazine)
  • Alverine — Antispasmodic
  • Alprazolam (Xanax) — Anxiolytic (benzodiazepine)
  • Amitriptyline (Elavil; Endep) — Tricyclic antidepressant
  • Amoxapine (Asendin) — Tricyclic antidepressant
  • Belladonna alkaloids — Antispasmodic
  • Chlorphenamine — Antihistamine
  • Clomipramine — Tricyclic antidepressant
  • Clorazepate (Tranxene) — Anxiolytic (benzodiazepine)
  • Codeine — Analgesic, antipyretic
  • Colchicine — Anti-hyperuricemic, anti-inflammatory
  • Dexchlorpheniramine — Antihistamine
  • Digoxin (Lanoxin) — Antiarrhythmic — cardiotonic
  • Furosemide (Lasix) — Diuretic, antihypertensive
  • Hydroxyzine (Hyzine, Vistaril) — Anxiolytic, antihistamine
  • Imipramine (Tofranil) — Tricyclic antidepressant
  • Levomepromazine — Neuroleptic (phenothiazine)
  • Maprotiline (Ludiomil) — Tetracyclic antidepressant
  • Opipramol — Tricyclic antidepressant
  • Orphenadrine — Antiparkinsonian
  • Oxybutynin (Ditropan) — Antispasmodic
  • Theophylline (asthma drug) — Bronchodilator, antiasthmatic
  • Trihexyphenidyl — Antiparkinsonian
  • Trimipramine (Surmontil) — Tricyclic antidepressant
  • Tropatepine — Antiparkinsonian

    Possible effects of anticholinergics on the peripheral nervous system and organs include:

  • Ataxia; loss of coordination
  • Decreased mucus production in the nose and throat; consequent dry, sore throat
  • Xerostomia or dry mouth
  • Cessation of perspiration; consequent increased thermal dissipation through the skin leading to hot, red skin
  • Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
  • Increased body temperature
  • Loss of accommodation (loss of focusing ability, blurred vision — cycloplegia)
  • Double vision (diplopia)
  • Increased heart rate (tachycardia)
  • Urinary retention
  • Diminished bowel movement, sometimes ileus
  • Increased intraocular pressure, dangerous for people with narrow-angle glaucoma
  • Shaking

    Possible effects in the central nervous system resemble those associated with delirium, and may include:

  • Confusion
  • Disorientation
  • Agitation
  • Short-term memory loss
  • Inability to concentrate
  • Respiratory depression
  • Wandering thoughts; inability to sustain a train of thought
  • Incoherent speech
  • Wakeful myoclonic jerking
  • Unusual sensitivity to sudden sounds
  • Illogical thinking
  • Photophobia
  • Visual disturbances
  • Periodic flashes of light
  • Periodic changes in visual field
  • Visual snow
  • Restricted or “tunnel vision”
  • Visual, auditory, or other sensory hallucinations
  • Warping or waving of surfaces and edges
  • Textured surfaces
  • “Dancing” lines; “spiders”, insects
  • Lifelike objects indistinguishable from reality
  • Rarely: seizures, coma and death

    The acute anticholinergic syndrome is completely reversible and subsides once all of the toxin has been excreted. Ordinarily, no specific treatment is necessary. However, in extreme cases, especially those that involves severe distortions of mental state, a reversible cholinergic agent such as physostigmine may be used.

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