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What are Anticholinergic Drugs?

Anticholinergic drugs are prescription medications used to treat and control involuntary muscle movement in the urinary tract, lungs, gastrointestinal tract, sweat glands, and other parts of the body. They work by inhibiting the parasympathetic nervous system

Doctors prescribe these drugs to treat everything from urinary incontinence to COPD to cholinergic toxicity. Strong anticholinergics are also used during surgery and given to people with Parkinson’s to control their involuntary muscle movements.

Older adults are most commonly prescribed these medications, but they are considered safe when used properly for people of all ages.

There are two different types of anticholinergic medications. One category affects the central nervous system and the other affects the peripheral nervous system and the neuromuscular junction. Some act as muscle relaxants while others affect various bodily functions. 

Some anticholinergic drugs block the effects of poisons and are used to treat exposure to toxins. 

Anticholinergics treat:

  • Vertigo
  • Motion sickness
  • Peptic ulcers
  • Diarrhea
  • Diverticulitis 
  • Ulcerative colitis
  • Nausea and vomiting
  • Cystitis
  • Prostatitis
  • Urethritis
  • Asthma
  • Chronic bronchitis
  • Parkinson’s disease
  • Chronic obstructive pulmonary disorder (COPD)
  • Extrapyramidal symptoms, which are a side effect of antipsychotic drugs
  • Short-term insomnia
  • Sinus bradycardia due to an overly sensitive vagus nerve

Additionally, anticholinergics are given to people exposed to nerve agent poisons, such as tabun, VX, soman, and sarin gas.

In the past, doctors prescribed anticholinergic drugs to treat psychiatric disorders, but this is rarely, if ever, the case today.

How Anticholinergics Work

Anticholinergics work by blocking acetylcholine from binding to receptors on nerve cells. This inhibits parasympathetic nerve impulses responsible for muscle movement throughout the body. 

These drugs stop involuntary actions such as:

  • Digestion
  • Salivation
  • Urination
  • Mucus secretion

Because of the effects of anticholinergics and how they work, these drugs produce certain common side effects, such as dry mouth and urinary retention.

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Why Would Someone Take an Anticholinergic?

Doctors prescribe anticholinergics for a variety of different reasons, including:

  • Preventing motion sickness and dizziness
  • Managing COPD
  • Easing overactive bladder and incontinence
  • Preventing asthmatic episodes
  • Managing gastrointestinal disorders
  • Treating toxin poisoning, including poisonous mushrooms symptoms
  • Managing symptoms of Parkinson’s disease
  • Managing symptoms of digestive and kidney diseases

These drugs are also administered during surgery to maintain normal bodily functions, such as heartbeat, and to decrease saliva secretions and relax the patient.

Anticholinergic Drugs List 

Anticholinergics are a class of drug and within that class are several specific drugs including:

  • Atropine (Atropen) treats certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and decreases saliva production during surgery.
  • Belladonna alkaloids reduce muscle spasms in the digestive or urinary tract, and reduce fluid secretions.
  • Benztropine mesylate (Cogentin) treats the symptoms of Parkinson's.
  • Clidinium treats gastrointestinal disorders, including peptic ulcers, irritable bowel syndrome (IBS), and gastritis.
  • Cyclopentolate (Cyclogyl) dilates pupils and paralyzes the iris muscle in the eye for diagnostic procedures.
  • Darifenacin (Enablex) reduces muscle spasms of the bladder and urinary tract.
  • Dicyclomine treats the symptoms of irritable bowel syndrome.
  • Fesoterodine (Toviaz) treats the symptoms of overactive bladder.
  • Flavoxate (Urispas) treats bladder symptoms such as frequent or urgent urination, increased nighttime urination, bladder pain, and incontinence.
  • Glycopyrrolate treats a certain type of stomach/intestinal ulcer.
  • Homatropine hydrobromide is used before eye examinations, before and after certain eye surgeries, and to treat certain eye conditions.
  • Hyoscyamine (Levsinex) treats peptic ulcers by controlling gastric secretion, visceral spasm, and hypermotility in spastic colitis, spastic bladder, cystitis, pylorospasm, and associated abdominal cramps.
  • Ipratropium (Atrovent) prevents bronchospasm, or narrowing airways in the lungs, in people with COPD (chronic obstructive pulmonary disease), including chronic bronchitis and emphysema.
  • Orphenadrine treats skeletal muscle conditions such as pain or injury by relaxing muscles.
  • Oxybutynin (Ditropan XL) treats symptoms of overactive bladder, such as frequent or urgent urination, incontinence, and increased night-time urination by reducing muscle spasms of the bladder and urinary tract.
  • Propantheline (Pro-banthine) treats peptic ulcers.
  • Scopolamine prevents nausea and vomiting caused by motion sickness or from the anesthesia used during surgery, also used to treat certain stomach or intestinal problems, muscle spasms, and Parkinson disease symptoms.
  • Methscopolamine treats peptic ulcers.
  • Solifenacin (VESIcare) treats symptoms of overactive bladder, such as frequent or urgent urination, and incontinence by reducing muscle spasms of the bladder and urinary tract.
  • Tiotropium (Spiriva) prevents the narrowing of the airways in the lungs in people with COPD, bronchitis, and emphysema.
  • Tolterodine (Detrol) treats an overactive bladder with symptoms of urinary frequency, urgency, and incontinence by reducing bladder muscle spasms.
  • Trihexyphenidyl treats symptoms of Parkinson's disease or involuntary movements due to the side effects of certain psychiatric drugs.
  • Trospium treats an overactive bladder and symptoms of urinary incontinence, frequency, and urgency by relieving spasms of the bladder.

What Effects do Anticholinergic Drugs Have on the Body?

Users can experience a variety of anticholinergic side effects, both intended and unpleasant. They vary based on the many drugs in this category. Effects range from mild and tolerable to severe and intolerable.

Side Effects 

Possible anticholinergic side effects include:

  • Blurred vision
  • Constipation
  • Confusion
  • Decreased saliva
  • Decreased sweating
  • Delirium
  • Drowsiness
  • Dry mouth
  • Hallucination
  • Memory problems
  • Sedation
  • Trouble urinating

Health Effects

In addition to the unintended anticholinergic effects users experience, there is also a risk of developing dementia with long-term use of these drugs. Be sure to speak to your doctor before using these drugs for an extended time.

Additionally, anticholinergics increase a user’s risk of heat exhaustion and heatstroke. This is due to the drug’s ability to decrease perspiration. When the body cannot perspire, its temperature rises and there is an increased risk of heat-related health problems. 

People using these drugs should be aware of the adverse effects and avoid:

  • Exercise
  • Hot weather
  • Hot baths

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Risks of Taking Anticholinergic Medications

The most immediate risk of using anticholinergic drugs is overdose from too much anticholinergic activity and anticholinergic toxicity. Using multiple drugs with anticholinergic properties increases the risk of overdose. 

Symptoms of an anticholinergic overdose include:

  • Breathing trouble
  • Confusion and cognitive impairment
  • Constipation
  • Delirium
  • Dizziness
  • Elevated heart rate 
  • Fever
  • Inability to urinate
  • Severe Drowsiness
  • Severe hallucinations
  • Severe
  • Slurred speech

Mixing anticholinergic agents with alcohol increases the risk of adverse effects and overdose. The mix severely affects cognitive function, creating a variety of secondary risks. Drinking alcohol while using the drugs also puts you at risk of losing consciousness and is potentially fatal.

Are Anticholinergic Drugs Addictive?

Yes. However, addiction to anticholinergics is less common than other drugs because these drugs do not produce a euphoric feeling. Anticholinergics generally treat specific conditions and aren’t sought after by recreational users. 

There are instances of people mixing anticholinergics with other medications or drugs, including alcohol or opioids. This creates a greater risk of toxicity. 

Anticholinergic drugs should only be used according to a doctor’s prescription.

Symptoms of Misuse & Addiction

The most common problem to occur when someone misuses anticholinergics is toxicity. This is also known as acute anticholinergic syndrome. It happens accidentally when people use multiple drugs with anticholinergic properties or as a result of misusing anticholinergics recreationally. 

Diagnosing anticholinergic toxicity is difficult unless a medical professional knows the patient ingested an anticholinergic drug. 

Doctors who understand anticholinergic properties and the effects of the drug and/or administer a lab test have a better chance of pinpointing anticholinergics as the specific cause of symptoms. 

Treatment for Anticholinergic Drug Misuse & Addiction

Misusing anticholinergics can lead to toxicity or anticholinergic poisoning. This is why you should only use these drugs according to professional medical advice. 

Additionally, doctors must consider a patient’s personal data and their entire anticholinergic burden before prescribing these medications. 

For some, especially older adults, anticholinergics are a potentially inappropriate medication if they are using other similar drugs. This is because age plays a role in the risk of developing conditions that are treated with anticholinergics. Too much anticholinergic activity puts a patient at risk of developing toxicity.

Any issues with toxicity must be addressed first before treatment for a potential addiction begins. 

Once toxicity is treated and any other effects of anticholinergics are dealt with using medications such as benzodiazepines, behavioral therapy, and counseling, rehabilitation is available for treating addiction to anticholinergics.

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Resources

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Merz, Beverly. “Common Anticholinergic Drugs like Benadryl Linked to Increased Dementia Risk - Harvard Health Blog.” Harvard Health Blog, 29 Jan. 2015, https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667.

Harvard Health Publishing. “Two Types of Drugs You May Want to Avoid for the Sake of Your Brain - Harvard Health.” Harvard Health, Harvard Health, 14 June 2018, https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain.

Harvard Health Publishing. “Two Types of Drugs You May Want to Avoid for the Sake of Your Brain - Harvard Health.” Harvard Health, Harvard Health, 14 June 2018, https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain.

“Anticholinergics and Antispasmodics (Oral Route, Parenteral Route, Rectal Route, Transdermal Route) Description and Brand Names - Mayo Clinic.” www.mayoclinic.org, https://www.mayoclinic.org/drugs-supplements/anticholinergics-and-antispasmodics-oral-route-parenteral-route-rectal-route-transdermal-route/description/drg-20070312.

“Bladder Control: Medications Can Relieve Urinary Problems.” Mayo Clinic, 2017, https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220.

“Clinical Practice Guidelines : Anticholinergic Syndrome.” www.rch.org.au, https://www.rch.org.au/clinicalguide/guideline_index/Anticholinergic_Syndrome/.

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