Amanantadine-                                                                                                                          co-admin of anticholinergics may increase in anticholinergic side effects.

Digoxin-                                                                                                                   Pharmacological effects may be increased.

Phenothiazines-                                                                                                                     Antipsychotic effect may be decreased by concurrent therapy.

Tricyclic antidepressants-                                                                                                      co-admin with anticholinergics may increase anticholinergic effects.

Adjunct therapy for treatment of peptic ulcer.

GI- altered taste perceptions, nausea, vomiting, dysphagia, heart burn, constipation, bloated feeling.

GU- urinary hesitancy and retension, impotence.

Cardiovascular- palpitation,bradycardia,tachycardia.

CNS-headcahe, flushing, nervousness, drowsiness, weakness.

Hypersensitivity to anticholinergic drugs

Special precautions:

Anticholinergic psychosis reported in sensitive individuals given anticholinergic drugs.

CNS signs and symptoms include confusion, disorientation, short term memory loss, hallucinations, dyssarthria, ataxia, coma.

Elderly patients may react with excitement. Safety on children below 12 years not established. May produce drowsiness, dizziness.

Patients should observe caution while driving or performing tasks requiring alertness.

Indications:

Adjunct therapy for treatment of peptic ulcer.

Dosage:

Not recommended for children below 12 years for management of peptic ulcer.

Oral- 1mg 3 times daily or 2mg 2 or 3 times daily. Maintenance - 1mg 2 times daily.

Gastrointestinal anticholinrgics/antispasmodics-

1. Usually taken 30 to 60 minutes before a meal.

2. May cause drowsiness, dizziness, or blurred vision, patients should observe caution while driving or performing tasks requiring alertness.

3. Notify physician if skin rash, flushing or eye pain occurs.

4. May cause dry mouth, difficulty in urination, constipation, or increased sensitivity to light. Notify physician, if these become severe.

Gastrointestinal anticholinergics/antispasmodics

Pharmacology:

These agents inhibit the muscranic actions of acetyl choline at postganglionic parasympathetic neuroeffector sites including smooth muscle, secretory glands and CNS sites. Pharmacokinetics: Belladona alkaloids- are rapidly absorbed after oral use. They readily cross blood-brain barrier, and affect the the CNS. The major difference betwen these agents is that atropine at usual therapeutic doses is a stimulant, wheras scopolamine is a CNS depressant.

Quaternary anticholinergics- Synthetic or semisynthetic derivatives structurally related to belladona alkaloids, they are poorly and unreliably absorbed orally. Since they do not cross the brain barrier, CNS effects are negligable.

Antispasmodics- The tertiary ammonium compounds have little or no antimuscarnic activity, and therefore no significant effect on gastric acid secretion. They exhibit a nonspecific direct relaxant effect on smooth muscles.

Gastrointestinal anticholinergics/antispasmodics

Pregnancy:

Safety for use during pregnancy has not been established. Use only when clearly needed.

Lactation:

Do not use in nursing mothers.