Anticholinergics constipation with

The Class I agents have many similar side effects and toxicities. The anticholinergic side effects include dry mouth, constipation, and urinary hesitancy and retention. Common gastrointestinal (GI) side effects include nausea, vomiting, diarrhea, and anorexia. Cardiovascular adverse effects are hypotension, tachycardia, arrhythmias, and myocardial depression, especially in patients with congestive heart failure. Common central nervous system (CNS) side effects are headache, dizziness, mental confusion, hallucinations, CNS stimulation, paraesthesias, and convulsions. 

Amantadine is used cautiously in patients with seizure disorders, psychiatric problems, renal impairment, and cardiac disease. Amantadine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine... 

Inhaled anticholinergics are well tolerated with the most common adverse effect being dry mouth. Occasional metallic taste has also been reported with ipratropium. Other anticholinergic adverse effects include constipation, tachycardia, blurred vision, and precipitation of narrow-angle glaucoma symptoms. Urinary retention could be a problem, especially for those with concurrent bladder outlet obstruction. 

The important adverse effects of the various antidepressants are often a function of their underlying pharmacologic profiles7,8 (Table 35-3). TCAs cause problematic sedative, anticholinergic, and cardiovascular adverse effects owing to their interaction with dirty receptors. While these adverse effects generally are considered to be common and bothersome, they can be quite serious in certain cases. For example, constipation in its... 

Anticholinergic side effects include dry mouth, blurred vision, constipation, and urinary retention. More serious reactions include forgetfulness, sedation, depression, and anxiety. Patients with preexisting cognitive deficits and the elderly are at greater risk for central anticholinergic side effects. 

Anticholinergic side effects (e.g., dry mouth, blurred vision, constipation, urinary retention, tachycardia, memory impairment, and delirium) and sedation are more likely to occur with the tertiary amine TCAs than with the secondary amine TCAs. 

Although anticholinergic (drying) effects contribute to efficacy, adverse effects such as dry mouth, difficulty in voiding urine, constipation, and potential cardiovascular effects may occur (see Table 79-1). Antihistamines should be used with caution in patients predisposed to urinary retention and in those with increased intraocular pressure, hyperthyroidism, and cardiovascular disease. 

Drugs with anticholinergic effects may cause delirium but also tachycardia, urinary retention, constipation, dry mouth and blurred vision... 

With long-term use, the most problematic side effect is weight gain. However, many antihistamines including diphenhydramine also possess potent anticholinergic effects. This can cause dry mouth, blurred vision, constipation, confusion, and urinary retention. Because anticholinergic effects are especially problematic for the elderly, we advise against the routine use of antihistamines to treat elderly patients with insomnia. 

When treating insomnia without depression, doxepin and amitriptyline (both tricyclic antidepressants) can be administered in low doses (25-100 mg) at bedtime. These antidepressants, however, do have troublesome anticholinergic side effects (dry mouth, constipation, blurred vision, dizziness) and adverse effects on the heart, and they can be lethal if taken in overdose. Because of their effect on heart function, these antidepressants should be avoided in patients with heart problems and administered cautiously, if at all, to those who are already receiving one of any number of newer antidepressants that inhibit the metabolism of the TCAs. 

Eideriy In 2 studies, the incidence of commonly reported anticholinergic adverse events in patients treated with trospium (including dry mouth, constipation, dyspepsia, UTI, and urinary retention) was higher in patients 75 years of age and older as compared with younger patients. This effect may be related to an enhanced sensitivity to anticholinergic agents in this patient population. 

Constipation may be caused by slow intestinal transition, pelvic floor dysfunction, bowel dysfunction like irritable Bowel syndrome and tumours, but can also be secondary to other diseases and life conditions. Many medicines cause constipation, for example opiates, calcium channel blockers and drugs with anticholinergic effects, e.g. antidepressants. 

Symptom patterns those with alternating constipation and diarrhoea and predominant constipation may benefit from high fibre diets (although excess fibre may bloat). Those with predominant diarrhoea may require simple peripheral opiate agonists (loperamide), but may also be helped by raised fibre intake. Pain may respond in part to explanation that it does not indicate serious illness and in part to spasmolytic therapy with anticholinergic agents which... 

Geriatric Considerations - Summary Glycopyrrolate does not cross the blood-brain barrier so is less likely to cause the central effects seen with anticholinergics such as atropine. Other anticholinergic side effects such as blurred vision, dry mouth, urinary retention, and constipation do occur and can limit the usefulness of this drug in the older adult. 

Because of the multiple receptor sites that TCAs bind to, there are a variety of possible side effects that can be seen in treatment. The blockade of muscarinic receptors leads to increased anticholinergic tone and subsequent anti-cholinergic side effects, especially in the gastrointestinal system. These include delirium, dry mouth, tachycardia, constipation, and urinary retention in adults. In children, anticholinergic side effects are often not seen with treatment (Geller et ah, 1992). Tricyclic antidepressant blockade of the presynaptic a 2 receptors leads to increased autonomic tone throughout the body, causing elevations in heart rate and blood pressure. 

Anticholinergic (dry mouth, constipation, blurred vision, hypotension—more common with low-potency agents) Weight gain Extrapyramidal reactions (dystonia, rigidity, tremor, akathisia, greater risk with higher potency) Drowsiness... 

Mirtazapine is associated with modest anticholinergic side effects, including dry mouth and constipation. Anticholinergic side effects and their management are discussed in the Tricyclic and Heterocyclic Antidepressants section later in this chapter. 

Anticholinergic side effects are categorized as peripheral or central. The most common peripheral side effects are dry mouth, decreased sweating, decreased bronchial secretions, blurred vision, difficulty with urination, constipation, and tachycardia. Bethanechol chloride, a cholinergic drug that does not cross the blood-brain barrier, may effectively treat these side effects at a dosage of 25-50 mg three times a day. 

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. 

The primary adverse effects of TCAs have been described in the previous text. Anticholinergic effects are perhaps the most common. These effects result in dry mouth, constipation, urinary retention, blurred vision, and confusion. They are more common with tertiary amine TCAs such as amitriptyline and imipramine than with the secondary amine TCAs desipramine and nortriptyline. The potent a-blocking property of TCAs often results in orthostatic hypotension. Hi... 

FIGURE 6—31. Side effects of the tricyclic antidepressants—part 2. In this diagram, the icon of the TCA is shown with its anticholinergic/antimuscarinic (Ml) portion inserted into acetylcholine receptors, causing the side effects of constipation, blurred vision, dry mouth, and drowsiness. 

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