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anticholinergic effects

Jonas Reinold, Francesca Palese, Federico Romanese, Giancarlo Logroscino, Oliver Riedel, Federica E Pisa
OBJECTIVES: To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). METHODS AND DESIGN: This retrospective cohort study included all patients aged ≥65 years with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, 2012-2014. Medications dispensed within 3 months before and after hospitalization, respectively, were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR)...
February 13, 2019: International Journal of Geriatric Psychiatry
Pingxiang Xu, Ying Liu, Liyun Wang, Yi Wu, Xuelin Zhou, Junhai Xiao, Jianquan Zheng, Ming Xue
To compare and evaluate the differences of stereoselective activity, the binding affinity, metabolism, transport and molecular docking of phencynonate isomers to muscarinic acetylcholine receptor (mAChR) were investigated in this study. The rotation stimulation and locomotor experiments were used to evaluate anti-motion sickness effects. The competitive affinity with [3 H]-QNB and molecular docking were used for studying the interactions between the two isomers and mAChR. The stereoselective mechanism of isomers was investigated by incubation with rat liver microsomes, a protein binding assay and membrane permeability assay across a Caco-2 cell monolayer using a chiral column HPLC method...
February 13, 2019: Scientific Reports
Yuichiro Haba, Takayoshi Shiga, Toshio Naito
A 24-year-old woman with atopic dermatitis and persistent fever (axillary temperature of 37-38 °C for 6 months) received combination ophthalmic drops containing tropicamide and phenylephrine (Mydrin® -P), which exacerbated her fever within 15 min after instillation. Her axillary fever reached 40.1 °C but resolved the following day. No new dermatological symptoms developed. Although the patient's fever may have been caused by either tropicamide or phenylephrine, neither of which have been reported to induce fever in topical formulations, atopic dermatitis and tropicamide's inhibitory effect on perspiration under hot and humid conditions may have been the more probable cause...
February 12, 2019: Drug Safety—Case Reports
Barbara J Zarowitz, James E Tisdale
BACKGROUND: The exponential increase in the number of medications associated with clinically important prolongation of the heart rate-corrected QT interval (QTc) places older adults at increased risk of arrhythmias including life-threatening torsade de pointes (TdP) and sudden death. Risk factors, other than age older than 65 years and female sex, include multiple concurrent drugs that prolong QTc and a variety of underlying predisposing conditions. Although electronic medical records and pharmacy dispensing systems can alert clinicians to the risk of QTc-prolonging therapy, more than 95% of safety alerts are overridden, and many systems have deactivated QTc drug interaction alerts...
February 12, 2019: Journal of the American Geriatrics Society
Ann M Arens, Tom Kearney
INTRODUCTION: Physostigmine is a tertiary amine carbamate acetylcholinesterase inhibitor. Its ability to cross the blood-brain barrier makes it an effective antidote to reverse anticholinergic delirium. Physostigmine is underutilized following the publication of patients with sudden cardiac arrest after physostigmine administration in patients with tricyclic antidepressant (TCA) overdoses. We completed a narrative literature review to identify reported adverse effects associated with physostigmine administration...
February 11, 2019: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Waed Al-Khalaileh, Rana Abu-Farha, Mayyada Wazaify, Marie Claire Van Hout
BACKGROUND: There has been a trend in the past five years in Jordan for ophthalmic anticholinergic preparations to be misused or abused. This is done mainly to experience mental altering effects such as mood changes, euphoria or hallucinations. Such products are mostly obtained from community pharmacies without a prescription. OBJECTIVES: This study aimed to observe the requests of ophthalmic preparations in community pharmacies in Amman, Jordan, and evaluating the most popular and frequently requested ophthalmic drops suspected of abuse...
January 30, 2019: Research in Social & Administrative Pharmacy: RSAP
Frank Vitinius, Steffen Escherich, Hans-Christian Deter, Martin Hellmich, Jana Jünger, Katja Petrowski, Karl-Heinz Ladwig, Frank Lambertus, Matthias Michal, Cora Weber, Martina de Zwaan, Christoph Herrmann-Lingen, Joram Ronel, Christian Albus
BACKGROUND: Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD. METHODS: Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways...
February 4, 2019: BMC Psychiatry
Romain Barus, Johana Béné, Julie Deguil, Sophie Gautier, Régis Bordet
Many risk factors are known to induce or precipitate dementia. Drugs acting via different mechanisms can modulate cognitive performance and exert either beneficial or deleterious effects on cognition through functional or neuropathological mechanisms. This review discusses the association between several classes of drugs and cognitive impairment and dementia risk. These drugs can be dichotomized into drugs targeting central nervous system disorders (e.g., anticholinergic drugs, antiepileptics, antipsychotics, benzodiazepines, and opioids) and drugs targeting non-central nervous system disorders (e...
February 4, 2019: British Journal of Pharmacology
Keisuke Obara, Lin Ao, Tsukasa Ogawa, Takumi Ikarashi, Fumiko Yamaki, Kazuhiro Matsuo, Takashi Yoshio, Yoshio Tanaka
The present study aimed to investigate the potential inhibitory effects of 21 clinically available hypnotics on acetylcholine (ACh)-induced contractions in rat urinary bladder smooth muscle (UBSM) in order to predict whether these hypnotics could induce voiding impairment. ACh-induced contraction in rat UBSM was inhibited only by diphenhydramine (a histamine H1 receptor antagonist) at a concentration that was clinically relevant. ACh-induced contraction was also significantly inhibited by flurazepam (a benzodiazepine hypnotic) and suvorexant (an orexin receptor antagonist), albeit at concentrations that substantially exceeded clinically achievable blood levels...
2019: Biological & Pharmaceutical Bulletin
Julia Herbert, Horst Thiermann, Franz Worek, Timo Wille
CONTEXT: Nerve agents like sarin or VX have repeatedly been used in military conflicts or homicidal attacks, as seen in Syria or Malaysia 2017. Together with pesticides, nerve agents assort as organophosphorus compounds (OP), which inhibit the enzyme acetylcholinesterase. To counteract subsequent fatal symptoms due to acetylcholine (ACh) accumulation, oximes plus atropine are administered, a regimen that lacks efficacy in several cases of OP poisoning. New therapeutics are in development, but still need evaluation before clinical employment...
January 30, 2019: Clinical Toxicology
David Misdrahi, Arnaud Tessier, Antoine Daubigney, Wassilios G Meissner, Franck Schurhoff, Laurent Boyer, Ophélia Godin, Ewa Bulzacka, Bruno Aouizerate, Meja Andrianarisoa, Fabrice Berna, Delphine Capdevielle, Isabelle Chereau-Boudet, Thierry D'Amato, Caroline Dubertret, Julien Dubreucq, Catherine Faget-Agius, Christophe Lançon, Jasmina Mallet, Christine Passerieux, Romain Rey, Aurélie Schandrin, Mathieu Urbach, Pierre Vidailhet, Pierre-Michel Llorca, Guillaume Fond
BACKGROUND: Extrapyramidal side effects (EPS) have been identified as a complication of antipsychotic treatment. Previous meta-analyses have investigated EPS prevalence and risk factors in randomized clinical trials with highly selected patients, but studies in real-world schizophrenia are missing. OBJECTIVE: To examine the prevalence and clinical correlates associated with EPS in a nonselected national multicenter sample of stabilized patients with schizophrenia...
January 8, 2019: Journal of Clinical Psychiatry
Yakup Albayrak, Murat Beyazyüz, Özlem Abbak, Ece Altındağ
Rabbit Syndrome is an uncommon side effect of antipsychotic treatment. Although it is usually associated with typical antipsychotics, it can also be related to atypical antipsychotics. Anticholinergics are the most accepted treatment approach in treating Rabbit Syndrome. Fluvoxamine is a member of selective serotonin reuptake inhibitors and it is a potent agonist of sigma 1 receptors. In this article, we report a Rabbit Syndrome case who has benefited from fluvoxamine, in terms of both depressive disorder and Rabbit Syndrome; and present the data on the effects of sigma 1 agonist fluvoxamine on numerous movement disorders...
February 28, 2019: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
Nobuo Okui
PURPOSE: To examine the efficacy and safety of non-ablative vaginal erbium:YAG laser (VEL) for the treatment of overactive bladder syndrome (OAB) compared with those of two other common pharmacotherapies, namely, anticholinergics and β3-adrenoceptor agonists. METHODS: Female subjects aged 60-69 years who presented with symptoms of OAB from 2015 to 2017 were assigned to three groups (n = 50) receiving treatment with an anticholinergic agent (4 mg fesoterodine), a β3-adrenoceptor agonist (25 mg mirabegron), or VEL (20 min/session of VEL performed thrice)...
January 28, 2019: World Journal of Urology
David O Riordan, Eimir Hurley, Carol Sinnott, Rose Galvin, Kieran Dalton, Patricia M Kearney, James D Halpin, Stephen Byrne
Background Academic detailing is a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits prescribers in their practice to provide evidence-based information. While academic detailing has been adopted in other countries, this strategy is not routinely used in Ireland. Objective The aim of this study was to assess the feasibility and acceptability to General Practitioners (GPs) of a pharmacist-led academic detailing intervention in Ireland. Setting General Practice in County Cork, Ireland...
January 22, 2019: International Journal of Clinical Pharmacy
Lowell B Anthony, Matthew H Kulke, Martyn E Caplin, Emily Bergsland, Kjell Öberg, Marianne Pavel, Dieter Hörsch, Richard R P Warner, Thomas M O'Dorisio, Joseph S Dillon, Pablo Lapuerta, Kenneth Kassler-Taub, Wenjun Jiang
BACKGROUND: Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience considerable morbidity and mortality; carcinoid syndrome may be associated with shorter survival. Carcinoid syndrome is linked to tumoral secretion of serotonin and other bioactive substances. The subsequent debilitating diarrhea and urgency to defecate pose significant health risks. In previous studies, telotristat ethyl, a tryptophan hydroxylase inhibitor, was effective and well tolerated in treating carcinoid syndrome diarrhea...
January 16, 2019: Oncologist
Taisuke Jo, Nobuaki Michihata, Hayato Yamana, Yusuke Sasabuchi, Hiroki Matsui, Hirokazu Urushiyama, Akihisa Mitani, Yasuhiro Yamauchi, Kiyohide Fushimi, Takahide Nagase, Hideo Yasunaga
Purpose: Patients with symptomatic COPD are recommended to use inhaled bronchodilators containing long-acting muscarinic receptor antagonists (LAMAs). However, bronchodilators may cause gastrointestinal adverse effects due to anticholinergic reactions, especially in advanced-age patients with COPD. Dai-kenchu-to (TU-100, Da Jian Zhong Tang in Chinese) is the most frequently prescribed Japanese herbal Kampo medicine and is often prescribed to control abdominal bloating and constipation...
2019: International Journal of Chronic Obstructive Pulmonary Disease
Peilin Xie, Zhen Zheng, Lihua Jiang, Songwei Wu
The present study sought to determine the pharmacological effects of penehyclidine, an anticholinergic agent, on the angiogenic capacity of pulmonary microvascular endothelial cells (PMVECs). In vitro Matrigel network formation assay, cell proliferation assay, cell-matrix adhesion assay, and wound-healing assay were performed in PMVECs with or without exposure to penehyclidine or, in some cases, glycopyrrolate or acetylcholine, over a concentration range. In addition, the phosphorylation state of Akt and ERK, as well as the endogenous level of mTOR and RICTOR were examined in PMVECs by Western blot following the cells exposure to penehyclidine or, for some proteins, glycopyrrolate or acetylcholine...
January 11, 2019: Pulmonary Pharmacology & Therapeutics
Roberta Esteves Vieira de Castro, Carolina da Cunha Sousa, Maria Clara de Magalhães-Barbosa, Arnaldo Prata-Barbosa, Elie Cheniaux
Ranitidine is a histamine-2 blocker commonly prescribed in PICUs for the prophylaxis of gastrointestinal bleeding and stress ulcers. However, it can be associated to central nervous system side effects, such as delirium, in adults. We present the first case of a child presenting delirium possibly caused by anticholinergic toxidrome secondary to the use of ranitidine, resolving after drug discontinuation. With this case report, we reinforce that a wide variety of clinical conditions can trigger delirium and that the best therapeutic approach is to minimize risk factors...
January 11, 2019: Pediatrics
Julie H Ishida, Charles E McCulloch, Michael A Steinman, Barbara A Grimes, Kirsten L Johansen
BACKGROUND: Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES: To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis...
January 10, 2019: Journal of the American Geriatrics Society
Jung Hyun Shin, Myung-Soo Choo
OBJECTIVES: To evaluate the effectiveness and persistence of mirabegron as a first-line treatment in patients with overactive bladder (OAB) in real-life practice. METHODS: We retrospectively analyzed patients with OAB who received mirabegron (50 mg) as a first-line treatment. According to treatment course, patients were divided into three groups, (a) mirabegron only (monotherapy group), (b) mirabegron and anticholinergics (add-on group), and (c) mirabegron replaced with another treatment (switch group)...
January 8, 2019: Lower Urinary Tract Symptoms
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