Yes

Anticholinergic Agent

Treatment of functional disturbances of GI motility such as irritable bowel syndrome

B

Hypersensitivity to any anticholinergic drug; narrow-angle glaucoma, myasthenia gravis; should not be used in infants <6 months of age; nursing mothers

Use with caution in patients with hepatic or renal disease, ulcerative colitis, hyperthyroidism, cardiovascular disease, hypertension, tachycardia, GI obstruction, obstruction of the urinary tract. The elderly are at increased risk for anticholinergic effects, confusion and hallucinations.

Adverse reactions are included here that have been reported for pharmacologically similar drugs with anticholinergic/antispasmodic action

Central nervous system: Dizziness, lightheadedness, tingling, headache, drowsiness, nervousness, numbness, mental confusion and/or excitement, dyskinesia, lethargy, speech disturbance, insomnia

Dermatologic: Rash, urticaria, itching, and other dermal manifestations; severe allergic reaction or drug idiosyncrasies including anaphylaxis

Endocrine & metabolic: Suppression of lactation

Gastrointestinal: Xerostomia, nausea, vomiting, constipation, bloated feeling, abdominal pain, taste loss, anorexia

Genitourinary: Urinary hesitancy, urinary retention, impotence

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision, diplopia, mydriasis, cycloplegia, increased ocular tension

Respiratory: Dyspnea, apnea, asphyxia, nasal stuffiness or congestion, sneezing, throat congestion

Miscellaneous: Decreased diaphoresis

Symptoms of overdose include CNS stimulation followed by depression, confusion, delusions, nonreactive pupils, tachycardia, hypertension

Anticholinergic toxicity is caused by strong binding of the drug to cholinergic receptors. For anticholinergic overdose with severe life-threatening symptoms, physostigmine 1-2 mg (0.5 mg or 0.02 mg/kg for children) S.C. or I.V., slowly may be given to reverse these effects.

Decreased effect: Phenothiazines, anti-Parkinson's drugs, haloperidol, sustained release dosage forms; decreased effect with antacids

Increased toxicity: Anticholinergics, amantadine, narcotic analgesics, type I antiarrhythmics, antihistamines, phenothiazines, TCAs

Protect from light

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS

Onset of effect: 1-2 hours

Duration: Up to 4 hours

Absorption: Oral: Well absorbed

Metabolism: Extensive

Half-life: Initial phase: 1.8 hours; Terminal phase: 9-10 hours

Elimination: In urine with only a small amount excreted as unchanged drug

Oral:

Infants >6 months: 5 mg/dose 3-4 times/day

Children: 10 mg/dose 3-4 times/day

Adults: Begin with 80 mg/day in 4 equally divided doses, then increase up to 160 mg/day

I.M. (should not be used I.V.): Adults: 80 mg/day in 4 divided doses (20 mg/dose)

Alcohol: Additive CNS effects, avoid use

Pulse, anticholinergic effect, urinary output, GI symptoms

May cause nervousness, excitement, insomnia, confusion, drowsiness, dyskinesia

Concurrent use with psychotropics may produce additive sedation and dry mouth

No information available to require special precautions

>10% of patients experience dry mouth

Take as directed before meals; do not increase dose and do not discontinue without consulting prescriber. Avoid alcohol and other CNS depressant medications (antihistamines, sleeping aids, antidepressants) unless approved by prescriber. Void before taking medication. This drug may impair mental alertness (use caution when driving or engaging in tasks that require alertness until response to drug is known); constipation (increased dietary fluid, fruit, or fiber and increased exercise may help). Report excessive and persistent anticholinergic effects (blurred vision, headache, flushing, tachycardia, nervousness, dizziness, insomnia, mental confusion or excitement, dry mouth, altered taste perception, dysphagia, palpitations, bradycardia, urinary hesitancy or retention, impotence, decreased sweating), change in color of urine or stools, or irritation or redness at injection site. Breast-feeding precautions: Do not breast-feed.

Raise bed rails, institute safety measures

Capsule, as hydrochloride: 10 mg, 20 mg

Injection, as hydrochloride: 10 mg/mL (2 mL, 10 mL)

Syrup, as hydrochloride: 10 mg/5 mL (118 mL, 473 mL, 946 mL)

Tablet, as hydrochloride: 20 mg

Beers MH, Ouslander JG, Rollingher I, et al, "Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents," Arch Intern Med, 1991, 151(9):1825-32.