Insomnia anticholinergic drugs

Tremor was observed in 30 patients (57.7%) and this mainly affected the limbs. In half the cases the tremor was evident before treatment with fluphenazine began but was made worse by the administration of the drug. Tremor was well tolerated in all but 6 patients. Akathisia occurred in 20 patients and caused malaise and insomnia in some which was relieved by hypnotics. Six patients (11.5%) developed acute dystonias, torticollis, movements of the tongue, opisthotonos and choreo-athetoid movements of the limbs which responded to treatment with anticholinergic drugs. Laboratory tests carried out during and at the conclusion of the study showed no abnormalities (17 -). 

Medications for symptomatic relief from vertigo consist of antiemetics, benzodiazepines and antihistamines. They are all mostly aimed at the psychological consequences of dizziness and can all have highly unfavourable side effects, for example, sedation, anticholinergic effects and insomnia. The psychological consequences of dizziness in elderly should rather be treated with information about the condition, supportive help actions and increased social activities, than with drugs. 

C. P. L. Freeman et al. (1994) compared the efficacy of fluvoxamine with that of CMI in a multicenter, randomized, double-blind, parallel-group comparison in 66 patients. Both drugs were equally effective and well tolerated, but fluvoxamine produced fewer anticholinergic side effects and caused less sexual dysfunction and more reports of headache and insomnia than did CMI. 

Insomnia, hypotension, agitation, headache, and rhinitis are the most common side effects of risperidone. These tend to lessen with time. Overall, the drug tends to be well tolerated. Average weight gain associated with risperidone after 10 weeks of treatment is 2.10 kg (AUison et al. 1999). Risperidone does not have significant anticholinergic side effects. Hyperprolactinemia is common. 

The four drugs were administered by psychiatrists blinded to treatment group assignment of patients. The 14-week study consisted of an 8-week dose escalation and fixed dose and a 6-week variable-dose period. The mean dose levels (mg/day) of the four compounds after the first 8 weeks were 452 for clozapine. 20.2 for olanzapine. 8.3 for risperidone and 19.6 for haloperidol. Patients on haloperidol received prophylactic anticholinergic medication to prevent extrapyramidal symptoms, and a few other drugs were permitted to treat agitation and insomnia. 

As with most data for reboxetine, this information primarily comes from summary papers rather than primary sources (473, 474). With this caveat, the adverse-effect profile of reboxetine is consistent with its pharmacology as an NSRI. Thus, it is similar to that of desipramine and maprotiline but without the risk of serious CNS (i.e., seizures, delirium) or cardiac (i.e., conduction disturbances) toxicity. The most common adverse effects of reboxetine are dry mouth, constipation, urinary hesitancy, increased sweating, insomnia, tachycardia, and vertigo. Whereas the first three adverse effects are commonly called anticholinergic, they are well known to occur with sympathomimetic drugs as well. In other words, these effects can be either the result of decreased cholinergic tone or increased sympathetic tone, although they tend to be more severe with the former than the latter. In contrast to TCAs, reboxetine does not directly interfere with intracardiac conduction. The tachycardia produced by reboxetine, however, can be associated with occasional atrial or ventricular ectopic beats in elderly patients. 

Many neuroleptics produce withdrawal symptoms that mimic the flu, including emotional upset, insomnia, nausea and vomiting, diarrhea, anorexia and weight loss, and muscle aches (chapter 4). This is particularly strong in drugs that have anticholinergic properties such as Thorazine and Mellaril. 

The major adverse effects of fluoxetine confirm its stimulant profile and its relative lack of anticholinergic actions. The most frequent adverse effects, which occurred in 10-25% of patients, were nausea (25%), nervousness, insomnia, headache, tremor, anxiety, drowsiness, dry mouth, sweating, and diarrhea (10%). Most of these adverse effects occurred early in treatment and seldom led to drug withdrawal. 

Bupropion is a well-tolerated antidepressant. It is non-sedating and lacks the cardiovascular and anticholinergic side effects of tricyclic antidepressants. Bupropion s most commonly observed adverse effects are insomnia and dry mouth. The drug is also known to be associated with a low rate of seizures however, no seizure incidents were reported in the smoking cessation clinical trials. Other less frequently occurring side effects include nervous system disturbances (mainlytremor) and skin rashes (170,182). 

Among the TCAs, desipramine and nortriptyline are the most recommended, since they have few anticholinergic side-effects. Sertraline has been studied in a placebo-controlled randomized trial and is considered one of the safest drugs for elderly patients post myocardial infarction, since it has no negative impact on cardiac measures. A number of placebo-controlled studies of post-stroke depression have shown efficacy for citalopram at doses of 10 mg and for nortriptyline (but not for fluoxetine). Venlafaxine may also be considered however, it should be used with caution since in 3-5% of patients it increases blood pressure. Mirtazapine may be used in patients with insomnia and decreased appetite due to its sedative side-effects and its promotion of increased appetite. ... 

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