Anticholinergics and antispasmodics form a group of prescription-only medicines used to treat spasms or cramps in the intestines, stomach and bladder. Encompassing the natural belladonna alkaloids (including hyoscyamine, scopolamine, atropine and belladonna), they are sometimes used in conjunction with other medicines (such as antacids) to treat stomach (peptic) ulcers. Other medicines in this group are used to combat nausea, prevent vomiting and stop motion sickness. They are commonly used before, during and after surgery, and in the prevention of certain types of poisoning.
Anticholinergics and antispasmodics are regularly used in specific emergency and surgical procedures. In surgery, they can be useful at several stages. Before the procedure begins, some may be given as pre-anesthetic injections to relax the patient and reduce saliva and other secretions. Glycopyrrolate, hyoscyamine, atropine and scopolamine are given during anesthesia to regulate the patient's heartbeat. Atropine is used in specific types of procedures via injection to relax the intestines and stomach. Post-surgery, scopolamine can also be given to stop nausea and vomiting after anesthesia.
Anticholinergics block the action of the neurotransmitter acetylcholine to treat a wide variety of conditions, including urinary incontinence, certain kinds of poisoning, chronic obstructive pulmonary disease (COPD), and involuntary muscle movements that may be experienced as part of some diseases. They are also used to regulate bodily functions during general anesthetic (surgery).
They work by stopping parasympathetic nerve impulses, which are responsible for involuntary muscular movements in the lungs, urinary tract, gastrointestinal tract, and elsewhere in the body. By controlling these impulses, anticholinergics can help to regulate digestion, salivation, mucus secretion and urination. That's why patients can experience dry mouth and may find they retain urine while taking an anticholinergic.
Anticholinergics, in particular, are used to counteract poisoning from certain medicines (including neostigmine and physostigmine), mushrooms, and some nerve agents and organic phosphorus pesticides (such as diazinon, parathion, malathion, ronnel (known as Trolene) and demeton (known as Systox)). They have also been used to treat runny noses, menstrual pain and urinary incontinence during sleep.
Antispasmodics are preoccupied with treating spasms in the gut and gastrointestinal tract. They can be sub-grouped into antimuscarinics (such as atropine and hyoscine) and smooth muscle relaxants (such as mebeverine).
Available on doctor's prescription only, anticholinergics and antispasmodics can be delivered in the following oral, parenteral, rectal, and transdermal routes, depending on the specific medicine used:
Most medicines can cause undesired (side) effects alongside their desired outcomes. Not all of the following side effects may occur, and they are listed in order of likelihood. Patients do not need to consult a physician if they experience some of the following, but a physician can advise about reducing them if they persist or become particularly bothersome to patients.
The following side effects are considered more serious and patients should consult a physician if they experience one or more of them.
Patients using scopolamine should be made aware of further side effects, particularly from withdrawal. Patients should reduce their dosage gradually, as directed by a physician.
All anticholinergic and antispasmodics may cause other side effects in some patients. They should consult their physician if they experience something not listed. Broadly, the side effects from the use of anticholinergics and antispasmodics are most commonly reported in pediatric and geriatric care, and in pregnant and breastfeeding women.
Side effects including heightened levels of nervousness, excitement, irritability and restlessness, along with noticeable warmth, flushing and dryness of the skin have been observed in children taking anticholinergics, where they are usually more sensitive than adults. In hot weather, children taking anticholinergics are more likely to experience a sharp increase in body temperature. For infants and children who have brain damage or spastic paralysis, anticholinergics may have more of an adverse effect. Children taking dicyclomine have reportedly experienced difficulty breathing and shortness of breath.
In geriatric care, anticholinergics and antispasmodics can cause or exacerbate neurological problems, including confusion and memory loss. They can also make urination difficult, increase drowsiness, dryness of the mouth, throat, nose or skin, and create unusual levels of restlessness, nervousness, excitement and irritability. More sensitive to the effects of anticholinergics in particular than younger adults, they may also experience the early signs of glaucoma, including eye pain.
Pregnant women should be advised of the following contraindications and limitations before prescription:
As with any medicine, it's important to take anticholinergics and antispasmodics only as directed by a physician. The doses for this group of medicines will vary by the route of delivery, the age and circumstances of the patient, and the specific medicine prescribed (including its concentration and strength, the amount of doses per day, the time permitted between doses, and the length of usage). The below information covers the average doses usually prescribed for this class of medicines. Do not change your dose if it is different from this information unless your doctor tells you to.
For oral route (tablets or capsules), the typical dose for elderly adults, adults and teenagers is 50mg, three times daily to treat stomach or duodenal ulcers. Doses for children will be determined by the physician.
For oral route (tablets or capsules), a typical dose for elderly adults, adults and teenagers is 300 to 1200mcg every four to six hours to treat stomach or duodenal ulcers, intestinal or urinary problems. Doses for children are based on body weight - typically 10mcg per kilogram of body weight every four to six hours, but no more than 400mcg every four to six hours.
For the parenteral (injection) route to treat stomach and duodenal ulcers or intestinal problems, doses for elderly adults, adults and teenagers are usually 400 to 600mcg injected under the skin or into a vein or muscle every four to six hours. Again, doses for children are based on body weight, with 10mcg injected under the skin for every kilogram of body weight, every four to six hours. In children, the dose should not exceed more than 400mcg every four to six hours.
When used to treat heart problems, a typical dose for older adults, teenagers and adults is 400 to 1000mcg every one to two hours injected into a vein as required. The total daily dose should not exceed 2mg. In children, the dose is again based on body weight. A typical dose is 10 to 30mcg per kilogram, injected into a vein.
The usual dose for teenagers, adults and older adults with stomach or duodenal ulcers or intestinal problems is 180 to 300mcg three to four times daily. Belladonna should be taken between 30 minutes and an hour before eating meals, and just before bed. Physicians may adjust the dose as required. In children, the typical dose is based on body weight on the basis of 9mcg per kilogram of weight three to four times per day.
Used to treat stomach and duodenal ulcers, a typical dose for adults, teenagers and older adults is 2.5 to 5mg three or four times per day. It should be taken before eating meals and before bed. Physicians may adjust the dose as required. There is no typical dose for children - it is determined by the physician if needed.
For the oral route (given as syrup, capsules or tablets), a typical dose to treat intestinal problems in adults, elderly adults and teenagers is 20mg four times daily. A physician may adjust this dose if required, but it normally does not amount to more than 160mg in total daily. Oral dicyclomine is not recommended for use with children, and use is contraindicated (not approved) for infants under the age of six months.
For dicyclomine injections, which are given intramuscularly, the usual dose for adults, teenagers and elderly adults to treat intestinal problems is 10 to 20mg injected four times a day. Dicyclomine injections are not recommended for use in children, and is contraindicated (not approved) for use in infants under the age of six months.
For the oral route (given in tablets) to treat stomach or duodenal ulcers in adults, older adults and teenagers, a typical dose is one to two milligrams two or three times daily. Some patients may also be recommended to take two milligrams before bed. Physicians may alter the dose if required, but the total daily dose should add up to no more than 8mg. Any dosage for children will be determined by the physician.
For the parenteral route (injections), Glycopyrrolate is typically given in doses of 100 to 200mcg injected intravenously or intramuscularly in elderly adults, teenagers and adults alike, to treat stomach or duodenal ulcers. Any dosage for children will be determined by the physician.
Given orally, homatropine is used to treat stomach or duodenal ulcers in doses of 5 to 10mg three to four times daily in adults, older adults and teenagers. Physicians may adjust the dosage if required. Doses for children will be decided by the physician.
For the oral route (given by elixir, tablets, capsules or oral solution), older adults, teenagers and adults usually take between 125 and 500mcg four to six times daily to treat stomach or duodenal ulcers, urinary or intestinal problems. Some patients are recommended a dose of 375mcg twice daily. Tablets should be taken between 30 minutes and an hour before eating a meal. Physicians may alter the dose if required. Dosage in children is based on body weight, with a typical dose of 12.5 to 187mcg given every four hours as required.
Hyoscyamine injections (the parenteral route) are typically taken every four to six hours as 250 to 500mcg injections into the muscle, a vein or under the skin of adults, older adults and teenagers to treat stomach or duodenal ulcers, or intestinal problems. For children, dosage will be determined by the physician.
To treat adults, older adults and teenagers experiencing intestinal problems or duodenal or stomach ulcers, the typical oral dose is 25 to 50mg four times per day. It should be taken with meals at just before bed. Physicians may adjust the dosage if required, and any dosage for children should be determined by a physician.
Given orally as tablets, methantheline is used to treat intestinal problems, stomach ulcers or urinary difficulties in adults, older adults, teenagers and children. A typical dose for adults is 50 to 100mg every six hours, but a physician may alter this dosage if required. In children aged older than one year, a usual dose is 12.5 to 50mg every six hours, but, again, a physician may adjust this if needed. Children aged between one month and one year are usually given a dose of 12.5mg four times daily. Infants younger then one month may be given a dose of 12.5mg two times per day, but a physician may alter this if required.
Taken orally as tablets, methscopolamine is used to treat intestinal problems and duodenal or stomach ulcers. A typical dose for elderly adults, teenagers and adults is 2.5 to 5mg four times daily, around half an hour before meals and just before bed. A physician may change this dose if needed. Dosages in children are based on body weight, where the usual dose is 200mcg per kilogram of weight, four times per day. This should also be taken just before meals and when it's time to go to bed.
A typical dose for adults, teenagers and older adults taking pirenzepine orally (as tablets) is 50mg twice a day: first thing in the morning and last thing at night. A physician may adjust this dose as required. Any doses for children will be determined by a physician.
Used to treat stomach or duodenal ulcers, propantheline is taken orally (as tablets). A typical dose for elderly adults, adults and teenagers is 7.5 to 15mg three times daily. It should be taken around half an hour before meals, with a further 30mg last thing at night. A physician may adjust this dose as required. Doses for children are based on body weight, with a usual dose consisting of 375mcg per kilogram of weight, four times per day. A physician may change this if needed.
Scopolamine is usually given in oral form (as tablets) to treat problems with urination or the intestines, or for painful menstruation. It is also available as an injection to treat urinary and intestinal issues, as a suppository (the rectal route) to treat urinary or intestinal issues, or painful menstruation, and as a transdermal patch to treat motion sickness or nausea and vomiting after surgery.
In oral form, a typical dose for adults, teenagers and the elderly is 10 to 20mg three to four times daily, although a physician may alter this if required. Any dosage in children must be decided by a physician. In injectable form, the usual dose for adults, older adults and teenagers is 10 to 20mg three to four times daily, and this may be adjusted by a physician if needed. Again, any dosage in children must be decided by a physician. As a suppository, adults, older adults and teenagers are usually given one 10mg suppository up to four times daily, but this may be adjusted by a physician if required. As before, any doses for children will be determined by your physician. As a transdermal patch to treat motion sickness, adults, older adults and teenagers are usually given one patch to be applied behind the ear at least four hours before nausea needs to be prevented. Use in this form for children is not advised. When treating vomiting and nausea after surgery, teenagers, older adults and adults are usually given one patch to place behind the ear the night before the surgical procedure to prevent the undesired symptoms. Use in children is also not recommended in this form.
Missed doses of most anticholinergics and antispasmodics should be taken as soon as possible once the patient remembers. If it's nearly time for the next dose, the patient should ignore the missed dose and proceed as they would normally so that there is no 'double dosing'.
Patients should fully inform their physician about any medication they may be taking - whether or not it is prescribed, over the counter or herbal. Some medicines create specific risks when taken together. However, sometimes two medicines may be used together even if there is small chance of interaction. A physician is the best source of information. They may choose to alter the dosages or put in place other strategies. The following medicines have known interactions with anticholinergics and antispasmodics based on their significance, but this should not be seen as an exhaustive list. Medicines in the anticholinergics and antispasmodics family are not recommended for use alongside any of the below medicines, but your physician may make changes to your other medication to allow you to be treated with a medicine in this class.
The following medicines are not recommended for use with anticholinergics and antispasmodics, but a physician may sometimes prescribe them in some cases. A physician should carefully consider altering the dose or the frequency of use of one or both of the medicines.
It's also important to note that some medicines should not be taken around the time of eating (or eating certain types of food) as interactions may happen. Drinking alcohol or smoking tobacco may also cause interactions with specific medicines. A physician can advise on any use of food, tobacco and alcohol while taking anticholinergics and antispasmodics.
It's not just interactions with other medicines to watch out for. Having another medical issue may affect how well anticholinergics and antispasmodics can work. Patients should inform their doctor if they have:
With any medicines, there are precautions to take. Overdosing on the belladonna alkaloid group of medicines, and drinking alcohol or using other central nervous system depressants (CNS) with scopolamine can be extremely dangerous, and can lead to death. Early signs of overdose include unsteadiness, dizziness, drowsiness, hallucinations, confusion, fever, breathing difficulties, heightened restlessness, nervousness, irritability or excitement, and flushed, dry skin.
Anticholinergics work by stopping certain bodily secretions, which can reduce a patient's ability to sweat. This can raise their body temperature, particularly during hot weather, exercise, in saunas or while taking hot baths. Patients should be made aware of this risk of heat stroke, as they may become faint or dizzy while they are taking anticholinergics.
For the same reason, anticholinergics can cause mouth, throat and nose dryness. Patients can suck on ice chips, sugar-free candy or gum, or use saliva substitutes to reduce the impact of dry mouth. Patients who experience dry mouth for more than two weeks should check with their physician as long-term dryness can raise the risk of dental disease (such as gum disease, tooth decay, and fungal infection).
Patients should not abruptly stop taking anticholinergics and antispasmodics unless under the guidance of a physician. They normally recommend a gradual reduction in dosage over time to avoid common side effects associated with withdrawal, including excessive sweating, dizziness, nausea and vomiting.
Both anticholinergics and antispasmodics can cause blurred vision for certain patients, along with increased optical sensitivity to light. Patients should ensure they have normal vision before attempting to drive or tackle anything else where reduced vision could pose a significant risk. Sunglasses may help to reduce any discomfort from light sensitivity.
Dizziness or drowsiness, particularly when dosages are high, is a common experience for many patients taking anticholinergics and antispasmodics. Lightheadedness and fainting can happen when patients stand up, so standing up slowly is recommended. Patients need to monitor their own levels of alertness before driving, operating machinery, or doing anything that could pose a risk if they feel dizzy or disoriented.
Scopolamine has specific warnings and side effects that patients should be made aware of. Scopolamine heightens the effects of drinking alcohol or using central nervous system depressants (CNS). CNS depressants include certain types of antihistamines, tranquilizers, sleeping medication, sedatives, narcotics or prescription pain medicines, medicines for seizures, muscle relaxants, barbiturates, and some anesthetics and dental anesthetics. Patients should fully inform their physician about any medicines or narcotics they may be taking before being prescribed scopolamine.
The specific storage instructions will vary between different anticholinergic or antispasmodic medicines, and will change depending on their delivery route. As with all medicines, patients should store them securely out of the reach of children or vulnerable adults. Medicines should be kept in sealed containers at room temperature, in a cool, moisture-free and dark place away from direct sunlight or heat. However, patients should not refrigerate or freeze anticholinergics or antispasmodics unless directed to by their physician.
Out of date, superfluous or leftover medicines should be disposed of responsibly at a physician's office or pharmacy, as recommended. Any liquid anticholinergics and antispasmodics (including injections and ampules) should be prevented from freezing. Patients should not refrigerate any syrup anticholinergics or antispasmodics.
Anticholinergics and antispasmodics form a group of helpful medicines that can be used in a variety of ways. Working to relieve cramps or spasms in the digestive system and bladder, they are also used to treat peptic ulcers (with antacids), dizziness, nausea and vomiting, and certain types of poisoning. Anticholinergics have also been used to treat painful menstruation and stop runny noses and urinary incontinence during sleep.
Care should be taken when taking any medicine, particularly the natural belladonna alkaloids (which include belladonna, scopolamine, atropine and hyoscyamine). Only available on prescription from a physician, anticholinergics and antispasmodics are known under a number of US brand names, including Artane, Bentyl, Cogentin, Cystospaz, Ditropan, Enablex, HyoMax, Hyosyne, Levsinex, Norflex, Nulev, Oscimin, Pamine, Pro-Hyo, Sanctura, Scopodex, Spasdel, Symax, Toviaz, Transderm Scop, Urispas, and Versicare. The physician and patient must work together to find the right medicine within the class, the right delivery route, and the right dosage, based on a number of factors.