Anticholinergic Drugs

Anticholinergics are a broad class of medications that are  involved in many disease and condition states.

An Anticholinergic Agent is a substance that works to stop or block Neurotransmitters in the Brain.

It inhibits parasympathetic nerve impulses.

Acetylcholine is the substance that is blocked.


All drugs can be divided into three Areas

1.)     Antimuscarinic Agents

2.)     Ganglionic Blockers

3.)     Neuromuscular Blockers


*** For our purposes – 2 Classifications will be used.


Medical Uses:

Gastrointestinal Disorders

-    Diarrhea
-    Nausea
-    Vomiting
-    Gastritis
-    Ulcerative Colitis
-    Diverticulitis
-    Others

Genitourinary Disorders

-    Cystitis
-    Urethritis
-    Prostatitis

Respiratory Disorders

-   Asthma
-   Acute and Chronic Bronchitis
-   Chronic Obstructive Pulmonary Disease or COPD

Sleeping Disorders

Heart Problems

-    Sinus Bradycardia


-    Vertigo
-    Motion Sickness




There are Two Broad Classifications of these Medication

1.)   Antimuscarinic Medications

Antimuscaranic medications or method of action affects the “muscarinic acetylcholine receptors

-    there is a reduction of action on these receptors


Examples of Antimuscarinic Medications


.        Atropine

Uses:  anaesthesia, bradycardia, anticholinesterase overdose or poisoning

Adverse effects: blurred vision, urinary retention

.        Scopolamine

Uses: motion sickness, nausea, cramping

.        Ipratropium brominde   [Atrovent HFA]

Uses: Asthma, Bronchitis, COPD

.        Tropicamide   [Mydriacyl]

Uses: Dilation of pupil

Adverse effects: Ocular Hypertension

.        Pirenzepine   [Gastrozepin]

Uses: Peptic Ulcers

.        Diphenhydramine   [Benadryl]

Uses: Antihistamine, sedative, hypnotic

.        Dimenhydrinate   [Dramamine]

Uses: Nausea, motion sickness

.        Dicycloverine

Uses: Irritable Bowel Syndrome

.        Flavoxate

Uses: Urinary Bladder Spasm

.        Oxybutynin   [Ditropan]

Uses: Urinary frequency, loss of bladder control

.        Tiotropium   [Spiriva]

Uses: COPD

.        Cyclopentolate  –  Eye drops

Uses: Pediatric Eye Examinations

.        Trihexyphenidyl   [Artane]

Uses: Parkinson’s disease, Extrapyramidal side effects

.        Tolterodine   [Detrol]

Uses: Urinary Incontinence

.        Solifenacin    [Vesicare]

Uses: Overactive Bladder

.        Darifenacin   [Enablex]

Uses: Urinary Incontinence, Overactive Bladder

.        Benzatropine   [Cogentin]

Uses: Parkinson’s Disease, Extrapyramidal side effects, Dystonia

.        Mebeverine   [Colofac]

Uses: Irritable Bowel Syndrome, GI spasms


Antinicotinic medications


-     Method of action affects the “nicotinic acetylcholine recptors

-     These compounds are often used during surgery for paralysis while others can be used for drug addiction.

They can be divided into a few categories

1.)   Ganglionic Blocking Agents

2.)   Neuromuscular Blocking Agents [Non-depolarizing]

3.)   Neuromuscular Blocking Agents [Depolarizing]

4.)   Centrally Acting Nicotinic Antagonists


Ganglionic Blocking Agents

.        Mecamylamine

Uses: Previously used in Hypertension now primarily used as a research tool

.        Trimethaphan   [Arfonad]

Method of Action: Binds and blocks the sympathetic nervous system and parasympathetic nervous system
Uses: Hypertensive Crisis, Dissecting Aortic Aneurysm, Pulmonary Edema, Bleeding during neurosurgery


Neuromuscular Blocking Agents [Non-depolarizing]

.        Atracurium

Uses: Anesthesia, Skeletal muscle relation

.        Doxacurium

Uses: Muscle relaxer

.        Mivacuriuim

Uses: Neuromuscular blocker or Muscle relaxant

.        Pancuronium

Uses: Muscle relaxant, General Anaesthesia – one of the drugs given during the “legal injection” in the United States
In some European countries such as Belgium and Netherlands is used in the protocol for euthanasia

.        Tubocurarine

Uses: Anaesthesia
Used rarely

.        Vecuronium   [Norcuron]

Uses: Muscle Relaxant


Neuromuscular Blocking Agents [Depolarizing]

.        Succinylcholine

Uses: Anesthesia, Emergency Medicine, Malignant Hypertension


Centrally Acting Nicotinic Antagonists

.        18-Methoxycoronaridine

Uses: Is still in the phase or research and hasn’t been tested on humans