Anticholinergic Drugs

What are anticholinergic drugs?

Anticholinergic drugs are medications that block acetylcholine (pronounced ah-set-ul-KO-leen). This neurotransmitter is a key part of how your parasympathetic nervous system works. Blocking it reduces certain kinds of nervous system activity.

Your autonomic nervous system has divisions to handle different jobs. Your sympathetic nervous system handles your “fight-or-flight” response. But that system needs another to balance it out, and that’s where your parasympathetic nervous system comes in. Experts sometimes call it the “rest-and-digest” or “feed-and-breed” system. That’s because it handles signals for resting, digesting food and sexual arousal.

What do anticholinergic drugs treat?

Over 600 medications have anticholinergic (pronounced ant-ee-KO-lin-er-jic) effects. For many of those drugs, that’s their main effect. Examples of anticholinergic drugs and some conditions they treat include:

• Atropine: treats slow heartbeat (bradycardia) and certain types of poisoning, like from industrial chemicals and chemical weapons (nerve gas)
• Benztropine: treats Parkinson’s disease and parkinsonism
• Diphenhydramine: the active ingredient in many over-the-counter sleep aids and allergy medications
• Glycopyrrolate: treats severe, chronic drooling and is useful for reducing salivation during medical procedures like surgeries
• Ipratropium: can help symptoms of asthma and chronic obstructive pulmonary disease (COPD)
• Oxybutynin: treats muscle spasms and related issues for people with conditions like benign prostatic hyperplasia and urge incontinence, and comes in topical forms for excessive sweating (hyperhidrosis)
• Scopolamine: eases nausea and vomiting that happen with motion sickness
• Solifenacin: can reduce the need to pee frequently that happens with urge incontinence
• Tiotropium: also treats asthma and COPD
• Tolterodine: can reduce bladder spasms that happen with urge incontinence
• Trihexyphenidyl: reduces muscle tremors that can happen with Parkinson’s disease and parkinsonism
• Vecuronium: paralyzes muscles to keep you from moving during surgeries and other medical procedures

But many medications only have anticholinergic properties as a side effect. Examples include:

• Tricyclic antidepressants for conditions like depression or chronic pain
• Antipsychotic medications for conditions like bipolar disorder or schizophrenia
• Antihistamines for allergies

What are the advantages of anticholinergic drugs?

Anticholinergic drugs have many important uses. Some are lifesaving and treat dangerous conditions. Others can improve your quality of life, making parts of your life a little better or easier.

What are the side effects of anticholinergic drugs?

It’s common for drugs to have anticholinergic effects, regardless of whether that’s their main purpose. Some of the most common side effects of anticholinergic drugs include:

• Being unable to pee (urinary retention)
• Blurred vision
• Confusion (altered mental status)
• Dry eyes
• Dry mouth
• Fast heart rate (tachycardia)
• High body temperature (hyperthermia)
• Pupils that are very dilated
• Skin that’s flushed and dry
• Slowed digestion
• Vomiting
• Weakened muscle strength (asthenia)

When should I see my healthcare provider?

You should see your healthcare provider if you notice any of the following:

• Your medications aren’t helping.
• It’s difficult to take your medications as prescribed.
• The side effects of a medication are disrupting your usual routine or activities.