Anticholinergic
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An anticholinergic agent is a member of a class of pharmaceutical compounds (such as Dicyclomine) which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system.
Anticholinergics are typically reversible competitive inhibitors of one of the two types of acetylcholine receptors, and are classified according to the receptors that are affected:
- antimuscarinic agents operate on the muscarinic acetylcholine receptors. (The majority of anticholinergics are antimuscarinics.)
- antinicotinic agents operate on the nicotinic acetylcholine receptors.
Effects
When a significant amount of anticholinergic is taken into the body, a toxidrome known as acute anticholinergic syndrome may result. This may happen accidentally or intentionally as a form of recreational drug use. This class of drug is usually considered the least "fun" by experienced drug users, possibly due to the lack of euphoria caused by anticholinergics. Because most users do not enjoy the experience, they do not use it again, or very rarely. Risk of addiction is low in the anticholinergic class. Effects are usually more pronounced in the elderly, due to the decrease of acetylcholine production associated with age.
Possible effects of anticholinergics 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
- Increased body temperature
- Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
- 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
- Respiratory depression
- Short-term memory loss
- Inability to concentrate
- 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
Acute anticholinergic syndrome is completely reversible and subsides once all of the toxin has been excreted. Ordinarily, no specific treatment is indicated. However, in extreme cases, especially those that involves severe distortions of mental state, a reversible cholinergic agent such as physostigmine may be used.
Plant sources
The most common plants containing anticholinergic alkaloids are:
- Atropa belladonna (Deadly Nightshade)
- Mandragora officinarum (Mandrake)
- Hyoscamus niger (Henbane)
- Datura species (Datura)
Abuse
Some drugs, such as hydrocodone, are mixed with small amounts of an anticholinergic, such as Homatropine Methylbromide to discourage abuse.
External links
Drugs for functional gastrointestinal disorders (A03) | |
|---|---|
| Drugs for functional bowel disorders | antimuscarinics: Mebeverine - Dicycloverine - Propantheline
papaverine and derivatives: Papaverine - Drotaverine - Moxaverine acting on serotonin receptors: 5-HT3 antagonists (Alosetron, Cilansetron) - 5HT4 agonists (Mosapride, Tegaserod) other: Diisopromine - Isometheptene - Phloroglucinol - Proglumide - Tridihexethyl |
| Belladonna and derivatives (antimuscarinics) | Atropine - Hyoscyamine - Butylscopolamine - Methylscopolamine |
| Propulsives | primarily dopamine antagonists (Metoclopramide/Bromopride, Domperidone, Alizapride) - serotonin agonists (Cisapride) - Clebopride |
Skeletal Muscle relaxants (M03) | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Peripherally acting (primarily antinicotinic, neuromuscular-blocking drugs) |
| ||||||||
| Centrally Acting |
| ||||||||
| Directly acting | Dantrolene | ||||||||
Anti-parkinson drugs: anticholinergic agents (N04A) | |
|---|---|
| Tertiary amines | Trihexyphenidyl - Biperiden - Metixene - Procyclidine - Profenamine - Dexetimide - Phenglutarimide - Mazaticol - Bornaprine - Tropatepine |
| Ethers chemically close to antihistamines | Etanautine - Orphenadrine |
| Ethers of tropine or tropine derivatives | Benzatropine - Etybenzatropine |
Drugs for obstructive airway diseases: asthma/COPD (R03) | |
|---|---|
| Adrenergics, inhalants | Short acting β2-agonists: Salbutamol/Levosalbutamol • Fenoterol • Terbutaline Long acting β2-agonists (LABA): Bambuterol • Clenbuterol • Formoterol • Salmeterol other: Epinephrine • Isoproterenol • Orciprenaline |
| Glucocorticoids | Beclometasone • Budesonide • Ciclesonide • Fluticasone • Mometasone |
| Anticholinergics | Ipratropium • Tiotropium |
| Mast cell stabilizers | Cromoglicate • Nedocromil |
| Xanthines | Aminophylline • Theobromine • Theophylline |
| Leukotriene antagonists | Montelukast • Pranlukast • Zafirlukast |
| Combination products | Budesonide/formoterol • Fluticasone/salmeterol • Ipratropium/salbutamol |
Ophthalmologicals: mydriatics and cycloplegics (S01F) | |
|---|---|
| Anticholinergics/antimuscarinics | Atropine - Scopolamine - Methylscopolamine - Cyclopentolate - Homatropine - Tropicamide |
| Sympathomimetics | Phenylephrine - Ephedrine - Ibopamine |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
ar:مضادات الكولين ca:Anticolinèrgic de:Anticholinergikumfr:Anticholinergique ja:抗コリン薬sk:Anticholinergikum sv:Antikolinergika
