Cholinergic drugs benefits

The central anticholinergic drugs having a higher central versus peripheral cholinergic action ratio are useful. The drugs like atropine are much less effective than levodopa but they are used when levodopa is not tolerated or contraindicated or the patient is not benefitted by levodopa or drug induced parkinsonism. 

In CONCLUSION, despite the very limited advances that have been made in developing drugs that are of real benefit to the patient with Alzheimer s disease, there have been some developments which may ultimately lead to this goal. The discovery of the defect in the forebrain cholinergic system has led to a treatment strategy which, although limited in its clinical value, raises the prospect of rational drug development. 

Symptomatic patients may benefit from the instillation of 0.1% to 0.125% pilocarpine into the affected eye three or four times daily. Because of individual variability, various low concentrations of pilocarpine should be attempted to determine the optimum concentration of miotic that alleviates symptoms as periocular discomfort, headache, photophobia, or blurred vision. If a miotic is used in this fashion, the patient should be carefully monitored in anticipation of modifying the drug regimen if the degree of cholinergic hypersensitivity changes over time. 

Patients with the Lambert-Eaton syndrome do not usually respond well to anticholinesterases. The drug 3,4-diaminopyridine (3,4-DAP) increases neurotransmitter release and also the action potential (by blocking potassium conductance) these actions lead to a nonspecific excitatory effect on the cholinergic system, and provide benefit. It should be taken orally, 4-5 times per day. Adverse effects... 

The modest improvements achieved in selectivity with respect to serotonin reuptake inhibition may also have been achieved with an isoenzyme system. Moclobemide, which was introduced in Sweden, reversibly inhibits monoamine oxidase A (RIMA). It is likely that this eliminates the severe hypertensive drug and food interactions that so severely limit the usefulness of the very effective earlier MAO inhibitors, since tyramine is now metabolized. An additional benefit of such agents may be a lack of cholinergic and cardiovascular effects. 

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