Heart failure anticholinergic drug

The major toxic reactions to disopyramide administration include hypotension, congestive heart failure, and conduction disturbances. These effects are the result of disopyramide s ability to depress myocardial contractility and myocardial conduction. Although disopyramide initially may produce ventricular tachyarrhythmias or ventricular fibrillation in some patients, the incidence of disopyramide-induced syncope in long-term therapy is not known. Most other toxic reactions (e.g., dry mouth, blurred vision, constipation) can be attributed to the anticholinergic properties of the drug. 

Disopyramide (Norpace and Norpace OR) Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used. High... 

This drug is only approved for oral administration in some countries. It is effective for conversion of atrial flutter or fibrillation or ischaemia-induced ventricular arrhythmias. It has significant anticholinergic properties (10% of the potency of atropine) that can offset its direct depressant effects on sinus and AV nodes. It has a pronounced negative inotropic effect and should be administered with caution to patients with a history of congestive heart failure. For acute treatment of perioperative arrhythmias it is given intravenously 0.2 mg-kg-1 over 10-15 min, then 0.2 mg-kg-1 over the next 45 min and a maintenance infusion of 0.4 mg-kg-l-h-1. 

Because of its potent anticholinergic properties, thioridazine shonld be used cautiously in patients with cardiac diseases snch as congestive heart failure, arrhythmias, angina pectoris, or heart block in encephalitis, Reye s syndrome, head injnry, respiratory disease, epilepsy and other seizure disorders, glaucoma, prostatic hypertrophy, urinary retention, Parkinson s disease, and pheochromocytoma because the drug may exacerbate these conditions and in hypocalcemia because it increases the risk of extrapyramidal reactions. 

Cardiovascular Among 82717 US veterans with a new diagnosis of COPD, who were followed until they had their first hospitalization for a cardiovascular event, or died, or reached the end of the study period, there were 6234 cardiovascular events (44% heart failure, 28% acute coronary syndrome, and 28% cardiac dysrhythmias) [27. The risk of cardiovascular events was increased in those who had used ipratropium in the past 6 months (HR=1.40 95% Cl = 1.3, 1.5). Among those who had used an anticholinergic drug more than 6 months before, there did not appear to be an increased risk of a cardiovascular event. This study was limited, owing to incomplete hospital admission data and lack of data on cardiovascular risk factors and severity of COPD. 

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