Anticholinergic drugs stroke

Heat prostration Heat prostration can occur with anticholinergic drug use (fever and heat stroke caused by decreased sweating) in the presence of a high environmental temperature. 

Tiotropium A potential association with cardiovascular risk has been suggested for long-acting anticholinergic drugs. In a 2-year randomized controlled study of the benefits of tiotropium versus fluticasone and salmeterol in 1323 patients with severe COPD, tiotropium was associated with significantly increased mortality (3% versus 6%), with an increase in cardiac events [86 ]. However, in a case series that specifically studied stroke in relation to tiotropium, there was no association [87 ]. 

Geriatric Considerations - Summary Bupropion has several advantages as an antidepressant agent for use in older adults. It has neither the anticholinergic or cardiac toxicities of the tricyclic antidepressants, and has fewer sexual side effects than selective serotonin reuptake inhibitors. Because this drug may lower seizure threshold, it should be used with caution in older adults with increased risk of seizures (e.g., previous stroke, early-onset Alzheimer s disease). 

A series of cases has been reported in which heat stroke occurred during hot weather, probably due to impaired heat adaptation in patients taking benzatropine and ethyl-benzatropine (544) this can occur with other anticholinergic and neuroleptic drugs as well. 

Rubin et at, J. Clin. Psychiatry 46, 418 (1985). Clinical trial in post-stroke depression J. R. Lipsey et ai, Lancet 1 297 (1984). Anticholinergic effect and clinical efficacy in urinary dysfunction I. Nissenkom et al., Eur. UroL 12, 109 (1986). Comprehensive description J. L. Hale in Analytical Profiles of Drug Substances vol. 1, K.. Florey, Ed. (Academic Press, New York, 1972) pp 233-247. 

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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