parasympatholytic (anticholinergic, antimuscarinic agent)
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Introduction
anticholinergic agent, anti-muscarinic agent.
Indications
- excessive bronchial secretions
- drying of bronchial secretions (also see inhaled anticholinergic agent)
- bronchoconstriction
- bradycardia
Contraindications
- conditions exacerbated by antimuscarinic agents
- avoid in the elderly, especially those with cognitive impairment[1][10]
Adverse effects
- dry skin#, dry mucous membrames, dry mouth
- mydriasis, blurred vision
- urinary retention
- risk of acute urinary retention greatest in 1st 30 days of therapy[4]
- constipation
- abdominal pain
- tachycardia
- dizziness
- drowsiness#
- nausea
- confusion, delirium, hallucinations
- hyperthermia
- thirst
- flushing, vasodilation
- chronic use may increase risk of mild cognitive impairment[12]
- chronic use may increase risk of dementia[3][11]
- use of 2 or more drugs with parasympatholytic effects increases risk of hospitalization for delirium or dementia (RR=2.6 for 2 drugs, 3.9 for 3 drugs)*[8]
- use of anticholinergics by cognitively nornal elderly is associated with increased brain atrophy & dysfunction & clinical decline[9]
- withdrawal: abrupt cessation can lead to cholinergic rebound symptoms,
* includes paroxetine, antipsychotics .
# distinguish from sympathomimetic amines -> diaphoresis, insomnia, anxiety
Notes
- see anticholinergic toxicity for overdose
More general terms
More specific terms
- aclidinium bromide (Tudorza Pressair, Bretaris, Eklira)
- aminopentamide (CENTRINE)
- amitriptyline (Elavil, Endep)
- atropine (Atropair, Atropine-Care)
- benztropine <mesylate> (Cogentin)
- biperiden (Akineton)
- butylscopolamine (Buscopan)
- caramiphen (Parpanil, Parpanit)
- cyclopentolate (Cyclogyl)
- dicyclomine (Bentyl)
- diphenhydramine (Benadryl, Alledryl, Allergival)
- ethopropazine (Parsidol)
- glycopyrrolate (Robinul, Cuvposa, Qbrexza)
- H1 receptor antagonist (antihistamine)
- homatropine (Isopto Homatropine)
- inhaled anticholinergic agent
- long-acting muscarinic receptor antagonist (LAMA)
- perenzepine
- procyclidine (Kemadrin)
- propantheline (Pro-Banthine)
- revefenacin (Yupelri)
- scopolamine (Transderm Scop, Hyoscine)
- sofpironium; ACTUAT sofpironium (Sofdra)
- trihexyphenidyl (Artane, Trihexy)
- tropsium
- urinary antispasmodic
Additional terms
Component of
References
- ↑ Jump up to: 1.0 1.1 Journal Watch 22(12):92, 2002 Roe CM et al Use of anticholinergic medications by older adults with dementia. J Am Ger Soc 50:836, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12028169 [PubMed
- ↑ Prescriber's Letter 16(6): 2009 Antimuscarinic Medications for Overactive Bladder Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250611&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 3.0 3.1 Carriere I et al Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: The 3-city study. Arch Intern Med 2009 Jul 27; 169:1317. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19636034
- ↑ Jump up to: 4.0 4.1 Martin-Merino E et al. Do oral antimuscarinic drugs carry an increased risk of acute urinary retention? J Urol 2009 Oct; 182:1442. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19683302
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ Prescriber's Letter 18(12): 2011 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271223&pb=PRL Drugs with Anticholinergic Activity (subscription needed) http://www.prescribersletter.com
- ↑ Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Jump up to: 8.0 8.1 Kalisch Ellet LM et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc 2014 Oct; 62:1916 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25284144
- ↑ Jump up to: 9.0 9.1 Risacher SL, McDonald BC, Tallman EF et al Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults. JAMA Neurol. 2016 Jun 1;73(6):721-32. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27088965
- ↑ Jump up to: 10.0 10.1 Dauphinot V et al. Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders. Alzheimers Res Ther 2017 Aug 1; 9:58. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28764796 Free PMC Article
- ↑ Jump up to: 11.0 11.1 Richardson K, Fox C, Maidment I et al Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29695481 Free PMC Article https://www.bmj.com/content/361/bmj.k1315
Gray SL, Hanlon JT Anticholinergic drugs and dementia in older adults BMJ 2018;361:k1722 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29695471 https://www.bmj.com/content/361/bmj.k1722 - ↑ Jump up to: 12.0 12.1 Weigand AJ et al. Association of anticholinergic medications and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology 2020 Oct 20; 95:e2295 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32878992 https://n.neurology.org/content/95/16/e2295
- ↑ Jump up to: 13.0 13.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ McCoy CE, Honda R. Anticholinergic Toxicity in the Emergency Department. J Educ Teach Emerg Med. 2023 Jan 31;8(1):S25-S47. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37465041 PMCID: PMC10332772 Free PMC article