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Anticholinergics (1/9)

• Anticholinergics (1/9): general pharmacology
• Anticholinergics (2/9): trospium chloride
• Anticholinergics (3/9): oxybutynin
• Anticholinergics (4/9): tolterodine
• Anticholinergics (5/9): fesoterodine
• Anticholinergics (6/9): propiverine
• Anticholinergics (7/9): darifenacin
• Anticholinergics (8/9): solifenacin
• Anticholinergics (9/9): butylscopolamine

Review literature Anticholinergic drugs: (Ouslander, 2004) (Yoshimura and Chancellor, 2002).

Mechanism of Action of Anticholinergic Drugs

Anticholinergic drugs act as antagonists on cholinergic (=muscarinic) receptors, this leads to smooth muscle relaxation of the bladder [see section receptors of the urinary bladder].

Indications for Anticholinergics:

• Autonomous detrusor contractions in neurogenic lower urinary tract dysfunction
• Overactive bladder
• Urge incontinence, urge symptoms in diseases like BPH, bladder infection, pelvic floor insufficiency, bladder catheterization ...
• Enuresis with urge symptoms oder overactivity of the bladder

Side Effects of Anticholinergics

Patients often do not complete the course of anticholinergic treatment due to the high rate of unwanted side effects:

Eye:

• Mydriases
• Disturbed accommodation
• Dry eyes due to inhibited lacrimal gland

GI tract:

• Dry mouth due to inhibited salivary glands
• Inhibition of intestinal motility (constipation)

Heart:

• Tachycardia

CNS:

• Dizziness, loss of concentration, drowsiness
• Aggravation of symptoms of dementia
• Headache
• Fear, anxiety and confusion are possible psychiatric side effects

Skin:

• Dry skin due inhibited sweat glands

Drug Interactions of Anticholinergics

Increased anticholinergic effect with antiparkinson drugs, antihistamines, antipsychotics, tricyclic antidepressants. Amplification of the tachycardic effect of sympathomimetic drugs. Anticholinergics mitigate the effects of gastrointestinal prokinetics.

Contraindications of Anticholinergics

• Narrow angle glaucoma
• Ileus, GI stenosis, severe inflammatory bowel disease, toxic megacolon
• Myasthenia gravis
• Tachyarrhythmias
• Urinary retention

References

Yoshimura und Chancellor 2002 YOSHIMURA, N. ; CHANCELLOR, M. B.: Current and future pharmacological treatment for overactive bladder.
In: J Urol
168 (2002), Nr. 5, S. 1897–913

  Deutsche Version: Anticholinergika