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parasympatholytic (anticholinergic, antimuscarinic agent)

anticholinergic agent, anti-muscarinic agent. Indications: 1) excessive bronchial secretions - drying of bronchial secretions (also see inhaled anticholinergic agent) 2) bronchoconstriction 3) bradycardia Contraindications: - conditions exacerbated by antimuscarinic agents - glaucoma, paralytic ileus, severe ulcerative colitis, toxic megacolon, myasthenia gravis, Sjogren's syndrome - avoid in the elderly, especially those with cognitive impairment [1,10] Adverse effects: 1) dry skin, dry mucous membrames, dry mouth 2) mydriasis, blurred vision 3) urinary retention - risk of acute urinary retention greatest in 1st 30 days of therapy [4] 4) constipation 5) abdominal pain 6) tachycardia 7) dizziness 8) drowsiness 9) nausea 10) confusion, delirium, hallucinations 11) hyperthermia 12) thirst 13) flushing, vasodilation 14) chronic use may increase risk of mild cognitive impairment [12] 15) chronic use may increase risk of dementia [3,11] 16) 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] 17) use of anticholinergics by cognitively nornal elderly is associated with increased brain atrophy & dysfunction & clinical decline [9] 18) withdrawal: abrupt cessation can lead to cholinergic rebound symptoms, - agitation, diarrhea, vomiting, tachycardia, & insomnia [13] * includes paroxetine, antipsychotics ... Notes: - see anticholinergic toxicity for overdose

Interactions

drug interactions drug adverse effects of parasympatholytics

Related

anticholinergic toxicity drugs with anticholinergic activity parasympathetic nervous system

Specific

aclidinium bromide (Tudorza Pressair, Bretaris, Eklira) aminopentamide (CENTRINE) amitriptyline (Elavil, Endep) atropine (Atropair, Atropine-Care) benztropine (Cogentin) biperiden (Akineton) butylscopolamine (Buscopan) caramiphen (Parpanil, Parpanit) cyclopentolate (Cyclogyl) dicyclomine (Bentyl) diphenhydramine (Benadryl, Alledryl, Allergival) ethopropazine (Parsidol) glycopyrrolate (Robinul, Cuvposa, Qbrexza) 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

General

autonomic agent

Properties

References

  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: 12028169 [PubMed
  2. Prescriber's Letter 16(6): 2009 Antimuscarinic Medications for Overactive Bladder Detail-Document#: 250611 (subscription needed) http://www.prescribersletter.com
  3. 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: 19636034
  4. Martin-Merino E et al. Do oral antimuscarinic drugs carry an increased risk of acute urinary retention? J Urol 2009 Oct; 182:1442. PMID: 19683302
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  6. Prescriber's Letter 18(12): 2011 Detail-Document#: 271223 Drugs with Anticholinergic Activity (subscription needed) http://www.prescribersletter.com
  7. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  8. 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: 25284144
  9. 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: 27088965
  10. 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: 28764796 Free PMC Article
  11. Richardson K, Fox C, Maidment I et al Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315 PMID: 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: 29695471 https://www.bmj.com/content/361/bmj.k1722
  12. 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: 32878992 https://n.neurology.org/content/95/16/e2295
  13. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022

Component-of

digestive enzymes/parasympatholytic