Cholinergic stimulants adverse effects

A dependency syndrome occurs in many who chew areca (Trivedy et al. 1999). This is not entirely suprising because other cholinergic stimulants (e.g., tobacco) also have addictive properties, and arecoline causes a release of dopamine like many other abused drugs. Use of areca persists despite adverse health effects—one of the criteria for addiction. 

Adverse effects Bethanechol causes the actions of generalized cholinergic stimulation (Figure 4.6). These include sweating, salivation, flushing, decreased blood pressure, nausea, abdominal pain, diarrhea, and bronchospasm. 

Q7 The adverse effects associated with cholinesterase inhibitors are related to excessive cholinergic stimulation. These include gastrointestinal disturbances such as abdominal cramps and nausea, salivation, sweating, flushing, bron-choconstriction and urinary incontinence. 

The acute form of diarrhea is short-lived and can be effectively prevented or rapidly suppressed by concomitant atropine. The cholinergic symptoms are accompanied by abdominal cramps (36%), sweating (57%), salivation (11%), visual disturbances (15%), lacrimation (12%), and piloerection (3%). The recommended dose of atropine is 0.25 mg intravenously for prevention or 0.25-1.0 mg for acute treatment of patients with early cholinergic symptoms. As cholinergic symptoms have not been observed with other camptothecin derivatives, it can be speculated that these adverse effects are restricted to irinotecan, whose piperidino group bears some structural similarity to the potent nicotine receptor stimulant dimethylphenylpiperazinium (106). 

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