Other commonly used names are: dicycloverine
, glycopyrronium bromide
, hyoscine hydrobromide
, hyoscine methobromide
, methanthelinium
, and octatropine
Description
The anticholinergics/antispasmodics
are a group of medicines that include the natural belladonna alkaloids (atropine,
belladonna, hyoscyamine, and scopolamine) and related products.
The anticholinergics/antispasmodics are used to relieve cramps or spasms
of the stomach, intestines, and bladder. Some are used together with antacids
or other medicine in the treatment of peptic ulcer. Others are used to prevent
nausea, vomiting, and motion sickness.
Anticholinergics/antispasmodics are also used in certain surgical and emergency
procedures. In surgery, some are given by injection before anesthesia to help
relax you and to decrease secretions, such as saliva. During anesthesia and
surgery, atropine, glycopyrrolate, hyoscyamine, and scopolamine are used to
help keep the heartbeat normal. Atropine is also given by injection to help
relax the stomach and intestines for certain types of examinations. Some anticholinergics
are also used to treat poisoning caused by medicines such as neostigmine and
physostigmine, certain types of mushrooms, and poisoning by ``nerve'' gases
or organic phosphorous pesticides (for example, demeton [Systox], diazinon,
malathion, parathion, and ronnel [Trolene]). Also, anticholinergics can be
used for painful menstruation, runny nose, and to prevent urination during
sleep.
These medicines may also be used for other conditions as determined by
your doctor.
The anticholinergics/antispasmodics are available only with your doctor's
prescription in the following dosage forms:
Oral
-
Anisotropine
-
Atropine
-
Tablets (U.S.)
-
Soluble tablets (U.S.)
-
Belladonna
-
Clidinium
-
Dicyclomine
-
Capsules (U.S. and Canada)
-
Syrup (U.S. and Canada)
-
Tablets (U.S. and Canada)
-
Glycopyrrolate
-
Tablets (U.S. and Canada)
-
Homatropine
-
Hyoscyamine
-
Extended-release capsules (U.S.)
-
Extended-release tablets (U.S.)
-
Elixir (U.S.)
-
Oral solution (U.S. and Canada)
-
Tablets (U.S. and Canada)
-
Mepenzolate
-
Methantheline
-
Methscopolamine
-
Pirenzepine
-
Propantheline
-
Tablets (U.S. and Canada)
-
Scopolamine
Parenteral
-
Atropine
-
Injection (U.S. and Canada)
-
Dicyclomine
-
Glycopyrrolate
-
Injection (U.S. and Canada)
-
Hyoscyamine
-
Scopolamine
-
Injection (U.S. and Canada)
Transdermal
-
Scopolamine
-
Transdermal disk (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,
the risks of taking the medicine must be weighed against the good it will
do. This is a decision you and your doctor will make. For anticholinergics/antispasmodics
the following should be considered:
Allergies--Tell your doctor if you have ever had any unusual or
allergic reaction to any of the natural belladonna alkaloids (atropine, belladonna,
hyoscyamine, and scopolamine), or any related products. Also, tell your health
care professional if you are allergic to any other substances, such as foods,
preservatives, or dyes.
Pregnancy--If you are pregnant or if you may become pregnant,
make sure your doctor knows if your medicine contains any of the following:
-
Atropine
--Atropine has not been shown
to cause birth defects or other problems in animals. However, when injected
into humans during pregnancy, atropine has been reported to increase the heartbeat
of the fetus.
-
Belladonna
--Studies on effects in
pregnancy have not been done in either humans or animals.
-
Clidinium
--Clidinium has not been
studied in pregnant women. However, clidinium has not been shown to cause
birth defects or other problems in animal studies.
-
Dicyclomine
--Dicyclomine has been
associated with a few cases of human birth defects but dicyclomine has not
been confirmed as the cause.
-
Glycopyrrolate
--Glycopyrrolate has
not been studied in pregnant women. However, glycopyrrolate did not cause
birth defects in animal studies, but did decrease the chance of becoming pregnant
and the newborn's chance of surviving after weaning.
-
Hyoscyamine
--Studies on effects in
pregnancy have not been done in either humans or animals. However, when injected
into humans during pregnancy, hyoscyamine has been reported to increase the
heartbeat of the fetus.
-
Mepenzolate
--Mepenzolate has not
been studied in pregnant women. However, studies in animals have not shown
that mepenzolate causes birth defects or other problems.
-
Propantheline
--Studies on effects
in pregnancy have not been done in either humans or animals.
-
Scopolamine
--Studies on effects in
pregnancy have not been done in either humans or animals.
Breast-feeding--Although these medicines may pass into the
breast milk, they have not been reported to cause problems in nursing babies.
However, the flow of breast milk may be reduced in some patients. The use
of dicyclomine in nursing mothers has been reported to cause breathing problems
in infants.
Children--Unusual excitement, nervousness, restlessness,
or irritability and unusual warmth, dryness, and flushing of skin are more
likely to occur in children, who are usually more sensitive to the effects
of anticholinergics. Also, when anticholinergics are given to children during
hot weather, a rapid increase in body temperature may occur. In infants and
children, especially those with spastic paralysis or brain damage, this medicine
may be more likely to cause severe side effects. Shortness of breath or difficulty
in breathing has occurred in children taking dicyclomine.
Older adults--Confusion or memory loss; constipation; difficult
urination; drowsiness; dryness of mouth, nose, throat, or skin; and unusual
excitement, nervousness, restlessness, or irritability may be more likely
to occur in the elderly, who are usually more sensitive than younger adults
to the effects of anticholinergics. Also, eye pain may occur, which may be
a sign of glaucoma.
Other medicines--Although certain medicines should not be used
together at all, in other cases two different medicines may be used together
even if an interaction might occur. In these cases, your doctor may want to
change the dose, or other precautions may be necessary. When you are taking
anticholinergics/antispasmodics, it is especially important that your health
care professional know if you are taking any of the following:
-
Antacids or
-
Diarrhea medicine containing kaolin or attapulgite or
-
Ketoconazole (e.g., Nizoral)--Using these medicines with an
anticholinergic may lessen the effects of the anticholinergic
-
Central nervous system (CNS) depressants (medicines that cause drowsiness)--Taking
scopolamine with CNS depressants may increase the effects of either medicine
-
Other anticholinergics (medicine for abdominal or stomach spasms
or cramps) or
-
Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine
[e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane],
doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g.,
Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])--Taking
anticholinergics with tricyclic antidepressants or other anticholinergics
may cause an increase in the effects of the anticholinergic
-
Potassium chloride (e.g., Kay Ciel)--Using this medicine with
an anticholinergic may make gastrointestinal problems caused by potassium
worse
Other medical problems--The presence of other medical problems may affect
the use of anticholinergics/antispasmodics. Make sure you tell your doctor
if you have any other medical problems, especially:
-
Bleeding problems (severe)--These medicines may increase heart
rate, which would make bleeding problems worse
-
Brain damage (in children)--May increase the CNS effects of
this medicine
-
Colitis (severe) or
-
Dryness of mouth (severe and continuing) or
-
Enlarged prostate or
-
Fever or
-
Glaucoma or
-
Heart disease or
-
Hernia (hiatal) or
-
High blood pressure (hypertension) or
-
Intestinal blockage or other intestinal problems or
-
Lung disease (chronic) or
-
Myasthenia gravis or
-
Toxemia of pregnancy or
-
Urinary tract blockage or difficult urination--These medicines
may make these conditions worse
-
Down's syndrome--These medicines may cause an increase in pupil
dilation and heart rate
-
Kidney disease or
-
Liver disease--Higher blood levels may occur and cause an increase
in side effects
-
Overactive thyroid--These medicines may further increase heart
rate
-
Spastic paralysis (in children)--This condition may increase
the effects of the anticholinergic
Proper Use of This Medicine
Take
this medicine only as directed
. Do not take more of it, do not take
it more often, and do not take it for a longer time than your doctor ordered.
To do so may increase the chance of side effects.
Dosing--The dose of the anticholinergic/antispasmodic
will be different for different patients.
Follow your
doctor's orders or the directions on the label
. The following information
includes only the average doses of your medicine.
If your
dose is different, do not change it
unless your doctor tells you to
do so.
The number of capsules or tablets or teaspoonfuls of solution or syrup
that you take depends on the strength of the medicine. Also,
the number of doses you take each day, the time allowed between doses, and
the length of time you take the medicine depends on the medical problem for
which you are taking this medicine
.
For anisotropine
-
For
oral
dosage forms (tablets):
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--50 milligrams (mg) three
times a day. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
For atropine
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers, intestine problems, or urinary
problems:
-
Older adults, adults, and teenagers--300 to 1200 micrograms
(mcg) every four to six hours.
-
Children--Dose is based on body weight. The usual dose is 10
mcg per kilogram (kg) (4.5 mcg per pound) of body weight every four to six
hours. However, the dose will not be more than 400 mcg every four to six hours.
-
For
injectable
dosage form:
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--400 to 600 mcg injected
into a muscle, vein, or under the skin every four to six hours.
-
Children--The dose is based on body weight. The usual dose is
10 mcg per kilogram (kg) (4.5 mcg per pound) of body weight injected under
the skin every four to six hours. However, the dose will not be more than
400 mcg every four to six hours.
-
To treat heart problems:
-
Older adults, adults, and teenagers--400 to 1000 mcg injected
into a vein every one to two hours as needed. The total dose will not be more
than 2 mg.
-
Children--The dose is based on body weight. The usual dose is
10 to 30 mcg per kilogram (kg) (4.5 to 13.6 mcg per pound) of body weight
injected under the skin.
For belladonna
-
For
oral
dosage form (oral solution):
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--180 to 300 micrograms (mcg)
three or four times a day. The dose should be taken 30 to 60 minutes before
meals and at bedtime. Your doctor may change the dose if needed.
-
Children--The dose is based on body weight. The usual dose is
9 mcg per kilogram (kg) (4 mcg per pound) of body weight three or four times
a day.
For clidinium
-
For
oral
dosage form (capsules):
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--2.5 to 5 milligrams (mg)
three or four times a day. The dose should be taken before meals and at bedtime.
Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
For dicyclomine
-
For
oral
dosage forms (capsules, extended-release
tablets, syrup, tablets):
-
To treat intestine problems:
-
Older adults, adults, and teenagers--10 to 20 milligrams (mg)
three or four times a day. Some people may take 30 mg two times a day. Your
doctor may change the dose if needed. Your dose will not be more than 160
mg a day.
-
Children 2 years of age and older--5 to 10 mg three or four
times a day. Your doctor may change the dose if needed.
-
Children 6 months to 2 years of age--5 to 10 mg of the syrup
three or four times a day. Your doctor may change the dose if needed.
-
Children up to 6 months of age--Use is not recommended.
-
For
injectable
dosage form:
-
To treat intestine problems:
-
Older adults, adults, and teenagers--20 mg injected into a muscle
every four to six hours. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
For glycopyrrolate
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--To start, 1 to 2 milligrams
(mg) two or three times a day. Some people may also take 2 mg at bedtime.
Your doctor may change the dose if needed. However, your dose will not be
more than 8 mg a day.
-
Children--Dose must be determined by your doctor.
-
For
injectable
dosage form:
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--100 to 200 micrograms (mcg)
injected into a muscle or vein. The dose may be repeated every four hours
up to four times a day.
-
Children--Dose must be determined by your doctor.
For homatropine
-
For
oral
dosage form:
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--5 to 10 milligrams (mg)
three or four times a day. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
For hyoscyamine
-
For
oral
dosage forms (capsules, elixir,
oral solution, tablets):
-
To treat duodenal or stomach ulcers, intestine problems, or urinary
problems:
-
Older adults, adults, and teenagers--125 to 500 micrograms (mcg)
four to six times a day. Some people may take 375 mcg two times a day. The
tablets should be taken 30 to 60 minutes before meals. Your doctor may change
the dose if needed.
-
Children--Dose is based on body weight. The usual dose is 12.5
to 187 mcg every four hours if needed.
-
For
injectable
dosage form:
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--250 to 500 mcg injected
into a muscle, vein, or under the skin every four to six hours.
-
Children--Dose must be determined by your doctor.
For mepenzolate
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--25 to 50 milligrams (mg)
four times a day, with meals and at bedtime. Your doctor may change the dose
if needed.
-
Children--Dose must be determined by your doctor.
For methantheline
-
For
oral
dosage form (tablets):
-
To treat intestine or stomach ulcers, intestine problems, or urinary
problems:
-
Older adults, adults, and teenagers--50 to 100 milligrams (mg)
every six hours. Your doctor may change the dose if needed.
-
Children 1 year of age and older--12.5 to 50 mg four times a
day. Your doctor may change the dose if needed.
-
Children 1 month to 1 year of age--12.5 mg four times a day.
Your doctor may change the dose if needed.
-
Children up to 1 month of age--12.5 mg two times a day. Your
doctor may change the dose if needed.
For methscopolamine
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--2.5 to 5 milligrams (mg)
four times a day, one-half hour before meals and at bedtime. Your doctor may
change the dose if needed.
-
Children--Dose is based on body weight. The usual dose is 200
micrograms (mcg) per kilogram (kg) (90.9 mcg per pound) of body weight four
times a day. The dose should be taken before meals and at bedtime.
For pirenzepine
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers or intestine problems:
-
Older adults, adults, and teenagers--50 milligrams (mg) two
times a day, in the morning and at bedtime. Your doctor may change the dose
if needed.
-
Children--Dose must be determined by your doctor.
For propantheline
-
For
oral
dosage form (tablets):
-
To treat duodenal or stomach ulcers:
-
Older adults, adults, and teenagers--7.5 to 15 milligrams (mg)
three times a day, one-half hour before meals, and 30 mg at bedtime. Your
doctor may change the dose if needed.
-
Children--Dose is based on body weight. The usual dose is 375
micrograms (mcg) per kilogram (kg) (170 mcg per pound) of body weight four
times a day. Your doctor may change the dose if needed.
For scopolamine
-
For
oral
dosage form (tablets):
-
To treat urinary problems or intestine problems or painful menstruation:
-
Older adults, adults, and teenagers--10 to 20 milligrams (mg)
three or four times a day. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
-
For
injectable
dosage form:
-
To treat urinary problems or intestine problems:
-
Older adults, adults, and teenagers--10 to 20 mg three or four
times a day. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
-
For
rectal
dosage form (suppository):
-
To treat urinary problems or intestine problems or painful menstruation:
-
Older adults, adults, and teenagers--Insert one 10 mg suppository
rectally three or four times a day. Your doctor may change the dose if needed.
-
Children--Dose must be determined by your doctor.
-
For
transdermal
dosage form (patch):
-
To treat motion sickness:
-
Older adults, adults, and teenagers--Apply one 500 to 1000 microgram
(mcg) patch behind ear at least four to twelve hours (depending on the product)
before antinausea effect is needed.
-
Children--Use is not recommended.
Missed dose--If you miss a dose of this medicine, take it as
soon as possible. However, if it is almost time for your next dose, skip the
missed dose and go back to your regular dosing schedule. Do not double doses.
For patients
taking any of these medicines by mouth
:
-
Take this medicine 30 minutes to 1 hour before meals unless otherwise
directed by your doctor.
To use the
rectal suppository
form of
scopolamine
:
-
If the suppository is too soft to insert, chill it in the refrigerator
for 30 minutes or run cold water over it before removing the foil wrapper.
-
To insert the suppository: First remove the foil wrapper and moisten
the suppository with cold water. Lie down on your side and use your finger
to push the suppository well up into the rectum.
To use the
transdermal disk
form of
scopolamine
:
-
This medicine usually comes with patient directions. Read them carefully
before using this medicine.
-
Wash and dry your hands thoroughly before and after handling.
-
Apply the disk to the hairless area of skin behind the ear. Do not
place over any cuts or irritations.
Storage--To store this medicine:
-
Keep out of the reach of children. Overdose is especially dangerous
in young children.
-
Store away from heat and direct light.
-
Do not store the capsule or tablet form of this medicine in the bathroom,
near the kitchen sink, or in other damp places. Heat or moisture may cause
the medicine to break down.
-
Keep the liquid form of this medicine tightly closed and keep it
from freezing. Do not refrigerate the syrup form of this medicine.
-
Do not keep outdated medicine or medicine no longer needed. Be sure
that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If you think you or someone else may have taken an overdose,
get emergency help at once
. Taking an overdose of any of the belladonna
alkaloids or taking scopolamine with alcohol or other CNS depressants may
lead to unconsciousness and possibly death. Some signs of overdose are clumsiness
or unsteadiness; dizziness; severe drowsiness; fever; hallucinations (seeing,
hearing, or feeling things that are not there); confusion; shortness of breath
or troubled breathing; slurred speech; unusual excitement, nervousness, restlessness,
or irritability; fast heartbeat; and unusual warmth, dryness, and flushing
of skin.
These medicines may make you sweat less, causing your body temperature
to increase.
Use extra care not to become overheated during
exercise or hot weather while you are taking this medicine
, since overheating
may result in heat stroke. Also, hot baths or saunas may make you dizzy or
faint while you are taking this medicine.
Check with your doctor before you stop using this medicine
. Your doctor may want you to reduce gradually the amount you are using
before stopping completely. Stopping this medicine may cause withdrawal side
effects such as vomiting, sweating, and dizziness.
Anticholinergics may cause some people to have blurred vision.
Make sure your vision is clear before you drive or do anything else that could
be dangerous if you are not able to see well
. These medicines may also
cause your eyes to become more sensitive to light than they are normally.
Wearing sunglasses may help lessen the discomfort from bright light.
These medicines, especially in high doses, may cause some people to become
dizzy or drowsy.
Make sure you know how you react to this
medicine before you drive, use machines, or do anything else that could be
dangerous if you are dizzy or are not alert
.
Dizziness, lightheadedness, or fainting may occur, especially when you
get up from a lying or sitting position. Getting up slowly may help lessen
this problem.
These medicines may cause dryness of the mouth, nose, and throat. For temporary
relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your
mouth, or use a saliva substitute. However, if your mouth continues to feel
dry for more than 2 weeks, check with your medical doctor or dentist. Continuing
dryness of the mouth may increase the chance of dental disease, including
tooth decay, gum disease, and fungus infections.
For patients taking
scopolamine
:
-
This medicine will add to the effects of alcohol and other CNS depressants
(medicines that slow down the nervous system, possibly causing drowsiness).
Some examples of CNS depressants are antihistamines or medicine for hay fever,
other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;
prescription pain medicine or narcotics; barbiturates; medicine for seizures;
muscle relaxants; or anesthetics, including some dental anesthetics.
Check with your doctor before taking any of the above while
you are using this medicine
.
For patients
taking any of these medicines by mouth
:
-
Do not take this medicine within 2 or 3 hours of taking antacids
or medicine for diarrhea. Taking antacids or antidiarrhea medicines and this
medicine too close together may prevent this medicine from working properly.
Side Effects of This Medicine
Along with its needed effects,
a medicine may cause some unwanted effects. Although not all of these side
effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible
if any of the following side effects occur:
Symptoms of overdose
Blurred vision (continuing) or changes in near vision; clumsiness or unsteadiness; confusion; convulsions (seizures); difficulty in breathing, muscle weakness (severe), or tiredness (severe); dizziness; drowsiness (severe); dryness of mouth, nose, or throat (severe); fast heartbeat; fever; hallucinations (seeing, hearing, or feeling things that are not there); slurred speech; unusual excitement,
nervousness, restlessness, or irritability; unusual
warmth, dryness, and flushing of skin
Other side effects may occur that usually do
not need medical attention. These side effects may go away during treatment
as your body adjusts to the medicine. However, check with your doctor if any
of the following side effects continue or are bothersome:
More common
Constipation (less common with hyoscyamine); decreased sweating; dryness of mouth, nose, throat,
or skin
For patients using
scopolamine
:
-
After you stop using scopolamine, your body may need time to adjust.
The length of time this takes depends on the amount of scopolamine you were
using and how long you used it. During this period of time check with your
doctor if you notice any of the following side effects:
Anxiety; irritability; nightmares; trouble in sleeping
For patients using the
transdermal disk
of
scopolamine
:
-
While using the disk or even after removing it, your eyes may become
more sensitive to light than usual. You may also notice the pupil in one eye
is larger than the other. Check with your doctor if this side effect continues
or is bothersome
Other side effects not listed above may also occur in
some patients. If you notice any other effects, check with your doctor.
