Anticholinergic agents include

- Oxybutynin chloride, Tolterodine Tartarate, Trospium Chloride, Solifenacin Succinate, Darifenacin Hydrobromide, Fesoterodine Fumarate Antiparkinson Agents- Anticholinergics Benztropine, Mesylate , Biperiden, Diphenylhydramine, Ethopropazine, Procyclidine, Trihexylphenidyl-

Refer Biperiden

ANTICHOLINERGICS-

Interacting drugs- summary 

+ Anticholinergics

Amantadine +                                                                                                                   coadmin. result in increased incidence of anticholinergic side effects Disappear when anticholinergic dose reduced                                                                                              

Digoxin +                                                                                                                           digoxin serum levels increased by anticholinergics when digoxin is administered as a slow dissolution oral tablet

 Haloperidol +                                                                                                             haloperidol and anticholinergic coadmin. result in worsening of schizophrenic symptoms, decreased haloperidol serum conc. and development of tardive dyskinesia

Levodopa +                                                                                                             anticholinergic decrease gastric motility resulting in increased deactivation of levodopa and decreased intestinal absorption, leading to reduction in levodopas efficacy

Phenothiazines +                                                                                                     pharmacologic /therapeutic actions of phenothiazines reduced by concurrent anticholinergics. Increase in the incidence of anticholinergic side effects occured

Adjunct therapy to Parkinsonism. 

ANTICHOLINERGICS-

Hypersensitivity- skin rash, urticaria, other dermatoses  

CNS - disorientation, confusion, memory loss,hallucination, psychoses, agitation,nervousness, delusions, delirium, paranoia, euphoria, excitement, lightheadedness, dizziness, headache, listlessness, depression, drowsiness, drowsiness, weakness, giddiness, paresthesia, heaviness of limbs

Cardiovascular - tachcardia, palpitations, hypotension, postural hypotension,mild bradycardia

GI - dry mouth, acute suppportive parotitis, nausea, vomiting, epigastric distress, constipation, dilationnof colon, paraleytic ileus, development of duodenal ulcer

Ophthalmic- blured vison, mydriasis, diplopia increased ocular tension, angle closure glaucoma, dilation of puplis

Renal- urinary retention, urinary hesitancy, dysuria

Musculoskeletal - muscular weakness, muscular cramping Miscellaneous- elevated temperature, flushing, numbness of fingers, decreased sweating, heat stroke, dificulty in acheiving or maintaining erection

ANTICHOLINERGICS-

Hypersentivity to any component, glaucoma, particularly angle closure glaucoma, pyloric or duodenal obstruction, stenosing peptic ulcer, ulcers, prostatic hypertrophy, or bladder neck obstruction, myasthenia gravis, megacolon

Warnings-

Ophthalmic- incipient narrow angle glaucoma may be precipitated by thes drugs. Peform onioscopy and closely monitor intraocular pressures at regular intervals

Elderly- geriatric patients > 60 years of age, frequently develop increased sensitivity to anticholinergics drugs and require strict dosage regulation. Occasional mental confusion and disorientation occur

Pregnancy - safety for use during pregnancy has not been established. Use only when clearly needed

Lactation- safety for use in nursing mother has not been established. An inhibitory on lactation may occur

Children- safety and efficacy for use in children has not been established

Special precautions:

Concomittant conditions- use caution in patients with tachcardia, cardiac arrhythmias, hypertension, hypotension, prostatic hypertrophy, ( elderly ) or tendency to urinary retention liver or kidney disorders

CNS - when used to treat patients with extrapyrimidal reactions resulting from phenothiazines in psychiatric patients, antiparkinson agents may excacerbate mental conditions and precipitate toxic psychosis

Heat illness - give with caution during hot weather, especially with other atropine -like drugs in elderly, the chronicaly ill, alchoholics, those with CNS disease and those work in hot environment

Dry mouth- if dry mouth is so severe that there is difficulty in swallowing or speaking or if loss of appetite and weight occurs, reduce dosage or discontinue the drug temporarily

Abuse potential - some patients may use these agents for mood elevations or psychedelic experiences. Cannabonolis , barbiturates, opiates and alcohol, have additive effects with anticholinergics. It is important, to be aware of this potential abuse situation

Hazardous tasks - may impair mental or physical abilites, patients should observe caution while driving or peforming other tasks requiring alertness

Indications:

Adjunct therapy to Parkonsinism.

Dosage:

2mg 3 to 4 times a day. Individualise dosage to a maximum of 16mg in 24 hours.

Antidykinetics are used to treat Parkinsons disease                                                     Antidykinetics- include Benzatropine, Bipereriden, Ethopropazine, Orocyclidine , and Trihexyphenedyl. Dose not apply to Amanatdine, Carbidopa, and Levodopa, Diphenhydramine, Haloperidol 

1. If GI upset occurs, may be taken with food

2. May cause drowsiness, dizziness, or blurred vision, obser adequate fluid intake ve caution while driving or performing other tasks that require alertness until response is known

3. Avoid alcohol or other CNS depressants

4. May cause dry mouth, sucking hard candy, adequate fluid intake or good oral hygiene may relieve the symptoms. difficult urination or constipation may occur, constipation can be relieved by use of stool softeners. Notify physician if effect persist..

5. Notify physician if rapid or pounding heartbeat , confusin, eye pain or rash occurs

6. Use caution in hot weather. This medication may increase suseptibility to heat stroke

7. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to antidyskinetics. Tell your doctor if you are allergic to any substances such as foods, preservatives or dyes.

8. Pregnancy- Antidyskinetics have not been to cause problems on humans.

9. Breast feeding- Mothers who are taking these medicines and whowish to breast-feed should discuss this with their doctor.

10. Children- Children are more sensitive to the effects of antidyskinetics. This may increase the chance of side effects in children.

11.. Elderly- Agitation, confusion disoreientation halucinations, memory loss, and mental changes are more likely to occur in elderly patients

12. Other medicines- Tell your doctor if your taking any of the following medicines- Anticholinergics- or Central nervous depressants that cause drowsiness or Tricyclic antidepresants - usually these medicines together with antidykinetics may result inadditive effects , increasing the chance of unwanted effects.

13. Other medical problems- Tell your if you have other medical problems especially- Difficult urination or Enlarged prostrate or Glaucoma or Heart or blood vessel disease or High blood presure or Intestinal blockage or Myastina gravis or Uncontrolled movements of hands.outh or tongue - antidykinetics may make the conditions worse                          Kidney disease or Liver disease- higher bloodlevels of the antidyskinetics may result, increasing the chance of side effects.

14. Missed dose- If you miss a dose of this medicine take it as soon as possible However if it is within 2 hours of your next dose skip the next dose and go back to your regular dosing schedule Do not double doses.

If GI upset occurs, may be taken with food

Pregnancy -

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

Lactation- safety for use in nursing mother has not been established. An inhibitory on lactation may occur

Children-

Safety and efficacy for use in children has not been established