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- What are anticholinergic and antispasmodic drugs? How do they work (mechanism of action)?
- What are anticholinergic and antispasmodic drugs used for?
- What are examples of prescription anticholinergic and antispasmodic agents available in the US?
- Drugs that have anticholinergic activity
- Overactive bladder (OAB) medications
- Antispasmodic medications
- Antidepressant medications
- Muscle relaxants
- Motion sickness medications
- Gastrointestinal medications
- Respiratory medications
- What are the side effects of anticholinergic and antispasmodic drugs?
- Who should not use anticholinergic and antispasmodic medications?
- What drugs interact with anticholinergic and antispasmodic drugs?
- What about taking anticholinergics and antispasmodic during pregnancy or while breastfeeding?
What are anticholinergic and antispasmodic drugs? How do they work (mechanism of action)?
Anticholinergic and antispasmodic drugs include a broad class of medications that are used to treat various medical conditions that involve contraction and relaxation of muscles. Examples of these conditions include overactive bladder, muscle spasms, breathing problems, diarrhea, gastrointestinal cramps, movement disorders, and others. Anticholinergics work by blocking the action of acetylcholine in the brain and at nerves. Neurotransmitters are chemicals made and released by nerves that travel to nearby nerves or, in the case of acetylcholine, nearby muscles and glands where they attach to receptors on the surface of the nerve, muscle, or glandular cells. The attachment of the neurotransmitter can stimulate or inhibit the activity of the receptor-containing cells. Anticholinergic drugs affect the function of many organs by preventing acetylcholine from binding to its receptors.
Anticholinergic drugs decrease the activity of muscles in the gut and reduce production of sweat, saliva, digestive juices, urine, and tears. Additionally, anticholinergic drugs help to balance the production of dopamine, another neurotransmitter that plays an important role in maintaining mood, movement, memory, attention, problem solving, motivation, and pleasure.
In addition to drugs that are primarily anticholinergic, there are drugs used for purposes other than nerve, muscle, or glandular problems which have some anticholinergic effects that are considered side effects, for example, antipsychotic and antidepressant drugs
What are anticholinergic and antispasmodic drugs used for?
What are examples of prescription anticholinergic and antispasmodic agents available in the US?
A variety of medications with anticholinergic properties are available for the treatment of various medical conditions.
Drugs that have anticholinergic activity
- Parkinson's medications
- diphenhydramine (Benadryl)
- trihexyphenidyl (Artane -- discontinued brand)
- benztropine mesylate (Cogentin)
- biperiden (Akineton) (This drug is no longer available in the U.S.)
- clomipramine (Anafranil)
- chlorpromazine (Thorazine -- discontinued brand)
- clozapine (Clozaril, Fazaclo ODT, Versacloz)
- fluphenazine (Prolixin -- discontinued brand)
- loxapine (Adasuve; Loxitane -- discontinued brand)
- olanzapine (Zyprexa, Symbyax)
- perphenazine (Trilafon -- discontinued brand)
- pimozide (Orap)
- quetiapine (Seroquel)
- thioridazine (Mellaril -- discontinued brand)
- thiothixene (Navane -- discontinued brand)
- trifluoperazine (Stelazine -- discontinued brand)
Overactive bladder (OAB) medications
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What are the side effects of anticholinergic and antispasmodic drugs?
- Blurred vision
- Dry mouth
- Dry eyes
- Decreased urine production
- Decreased sweat production
- Memory impairment
When possible, the use of anticholinergics should be avoided in the elderly because anticholinergic side effects are particularly common and problematic in older individuals.
Who should not use anticholinergic and antispasmodic medications?
Patients with the following medical conditions should not use medications with anticholinergic properties since use of anticholinergic medications can worsen their conditions:
What drugs interact with anticholinergic and antispasmodic drugs?
The use of multiple drugs with anticholinergic properties may be problematic because of their cumulative anticholinergic side effects. Examples of medications with anticholinergic properties that should not be combined include:
- Certain antidepressants
- Histamine 1-receptor blockers (H1RA)
- Anti-diarrheal medications
- Parkinson's medications
- Overactive bladder (OAB) medications
- Motion sickness medications
- Certain antiemetics
Patients are advised to consult with their doctor or pharmacist for more information regarding potential drug interactions.
What about taking anticholinergics and antispasmodic during pregnancy or while breastfeeding?
Most of the available anticholinergic medications have not been adequately studied in pregnant women. Patients who are pregnant or plan on becoming pregnant should consult with their doctor before starting a regimen that contains anticholinergic medications.
Many drugs can enter human milk and cause unwanted side effects in the nursing baby. Therefore, all medications should be used cautiously in nursing mothers. The prescribing information for each drug should be consulted for recommendations about use while breastfeeding.
Anticholinergic or antispasmodic drugs include prescription medications used to treat a variety of medical conditions. Review anticholinergic drug side effects, drug interactions, storage, dosing, and pregnancy and safety information prior to taking this medication.
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Related Disease Conditions
Peptic Ulcer (Stomach Ulcer)
Peptic or stomach ulcers are ulcers are an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to H. pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking. Symptoms of peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Diarrhea is a change is the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.
Nausea and Vomiting
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. There are numerous cases of nausea and vomiting. Some causes may not require medical treatment, for example, motion sickness, and other causes may require medical treatment by a doctor, for example, heart attack, lung infections, bronchitis, and pneumonia. Some causes of nausea and vomiting may be life-threatening, for example, heart attack, abdominal obstruction, and cancers. Treatment of nausea and vomiting depends upon the cause.
Parkinson's disease is a slowly progressive neurological disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Asthma: Over the Counter Treatment
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
COPD (Chronic Obstructive Pulmonary Disease)
COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema. Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD includes GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
Urinary Incontinence in Women
Millions of women suffer from urinary incontinence (UI). UI occurs twice as often in women as in men. There are many types of urinary incontinence: stress incontinence, urge incontinence, overactive bladder, functional incontinence, overflow incontinence, transient incontinence, and mixed incontinence.
Motion sickness is a feeling of unwellness caused by the inner ear and balance systems. Motion sickness can include sea sickness, car sickness, and train or plane sickness. Symptoms include, headache, nausea, vomiting, fatigue, dizziness, cold sweats, and pale skin. Treatment for motion sickness includes home remedies such as ginger, avoiding large or fatty meals prior to traveling, and OTC and prescription medications.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered-dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC asthma drugs like Primatene Mist and Bronkaid.
Urinary Incontinence in Children
Urinary incontinence in children (enuresis) is twice as common in boys as in girls and may occur during the daytime or nighttime. Nighttime urinary incontinence is also called bedwetting and sleepwetting. The cause of nighttime incontinence in children is unknown. Daytime incontinence in children may be caused by an overactive bladder. Though many children overcome urinary incontinence naturally, it may be necessary to treat incontinence with medications, bladder training and moisture alarms, which wake the child when he or she begins to urinate.
Overactive Bladder (OAB)
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Parkinson's Disease: Eating Right
Eating a well-balanced and nutritional diet is very beneficial to people with Parkinson's disease. With a proper diet, our bodies work more efficiently and it is especially helpful because Parkinson's disease medications will work properly.
Adult-onset asthma is asthma that is diagnosed in people over 20 years of age. Symptoms include wheezing, coughing, shortness of breath and difficulty breathing. Treatment may involve anti-inflammatory medications or bronchodilators.
Treatment & Diagnosis
Medications & Supplements
- Antidepressants (Depression Medications)
- tizanidine (Zanaflex)
- diphenhydramine, Benadryl
- cyclobenzaprine (Flexeril, Amrix, Fexmid)
- quetiapine (Seroquel)
- scopolamine - transdermal, Transderm-Scop
- olanzapine - oral, Zyprexa
- methocarbamol (Robaxin)
- ipratropium bromide inhaler (Atrovent)
- amitriptyline (Elavil, Endep)
- olanzapine (Zyprexa, Zydis)
- loperamide (Imodium)
- dicyclomine, Bentyl
- meclizine, Antivert, Bonine, Meni-D, Antrizine
- promethazine, Phenergan, Phenadoz, Promethegan
- orphenadrine (Norflex)
- hyoscyamine sublingual (Levbid, Levsin)
- atropine (Atreza)
- oxybutynin (Ditropan, Oxytrol, Anturol, Gelnique)
- benztropine (Cogentin)
- Cyclobenzaprine (Flexeril) vs. carisoprodol (Soma)
- carisoprodol (Soma)
- chlorpromazine - oral, Thorazine
- clozapine (Clozaril, Fazacio ODT, Versacloz)
- nortriptyline (Pamelor)
- clomipramine (Anafranil)
- doxepin (Sinequan and Adapin are discontinued brand in the US; Silenor)
- atropine eye drops
- chlorpromazine-injection, Thorazine
- hyoscine (scopolamine)-injectable
- promethazine and codeine, Phenergan with Codeine
- scopolamine, Transderm-Scop
- tolterodine (Detrol)
- desipramine (Norpramin)
- imipramine (Tofranil)
- pimozide - oral, Orap
- loxapine - oral, Loxitane
- hyoscyamine - disintegrating oral tablet, Nulev
- trospium - oral, Sanctura
- trimipramine (Surmontil)
- fluphenazine (Permitil, Prolixin)
- ipratropium solution - inhalation, Atrovent
- dantrolene - oral, Dantrium
- fluphenazine liquid - oral, Prolixin
- thioridazine (Mellaril [discontinued])
- thiothixene - oral, Navane
- fluphenazine concentrate - oral, Prolixin
Prevention & Wellness
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Drugs with Anticholinergic Activity. Prescriber's Letter 2011; 18 (12):271233.