Anticholinergic agents include - Oxybutynin chloride, Tolterodine Tartarate, Trospium Chloride, Solifenacin Succinate, Darifenacin Hydrobromide, Fesoterodine Fumarate 

Dry mouth, constipation, blurred vision, nausea, abdominal discomfort, facial flushing, ( more marked in children), difficulty in micturition ( less commonly urinary retention) are some of the pronounced side effects.

Other side effects

include headache, dizziness, drowsiness, dry skin, rash, angioedema, photosensitivity and diarrhoea. Rarely arrhthymia, restlessness, disorientation, hallucination, (children at higher risk of excitatory effects), and convulsions.

Oxybutynin is contraindicated in patients with -

1. Intestinal obstruction or atony

2. Severe ulcerative colitis or toxic megacolon

3. Significant bladder outflow obstruction

4. Glucoma

5. Myastenia gravis

Special precautions:

Elderly Use with caution in the elderly and patients with autonomic neuropathy, hepatic or rena disease.

Doses administered to patients with ulcerative colitis amy suppress GI motility and produce paralytic ileus and percipitate or aggravate toxic megacolon. Cardiac effects- symptoms of hyperthyroidism, coronary herat disease, congestive heart failure, cardiac aerrhythmias, tachycardia, hypertension, hiatial hernia, and prostatic hyperthrophy may be aggravated Potentially hazardous tasks- may produce drowsiness or dizziness, patients should observe caution while driving or performing tasks requiring alertness, coordination or physical dexterity.

Warnings-

Heat prostration- when adminsitered in presence of high environmental temperature, heat prostration (fever and heat stroke) may ocur due to decreased sweating Dirrrhea- may be early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy discontinue treatment.

Pregnancy-

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

Lactation-

excercise cautin while administering to a nursing woman Children- safety and efficacy in children < 5 years of age have not been established

Adult-

the usual dose is 5mg 2 or 3 times a day. This may be increased to a maximum of 5mg 4 times a day, to obtain a clinical response. Elderly- (including frail elderly)- the elimination half-life is increased in the elderly.

Therefore, a dose of 2.5mg twice a day, particularly if the patient is frail is likely to be adequate. This dose may be triturated upwards to a maximum of 5mg, 2 times a day, to obtain a clinical response.

Children (under 5 yrs of age)- is not recommended. Children( over 5 yrs of age) - neurogenic bladder; the usual dose is 2.5mg. twice a day.This may increased to 5mg , 2 or 3 times a day to get a clinical response. The last dose should be given bed time. Overdosage- Symptoms Signs of CNS excitation, (eg restlessness, tremor, irritability, convulsions, delirium, hallucinations), flushing, fever, nausea, tachycardia, hypotension, or hypertension, respiratory failure,paralysis, coma

Treatment

1. Should be symptomatic and supportive.

2. Maintain respiration and induce emesis or perform gastric lavage (emesis is contraindicated in precomatose, convulsive or psychotic state )

3. Activated charcoal may be administered as well as cathartic

4. Physostigmine may be considered to reverse symptoms of anticholinesterase intoxification

5. Treat hyperpyrexia symptomatically with ice bags or other cold applications and alcohol sponges

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Pregnancy-

Safety for use during pregnancy has not been established.

Use only when needed. Lactation- Excercise cautin while administering to a nursing woman

Children-

Safety and efficacy in children < 5 years of age have not been established