Anticholinergic Intoxication

Anticholinergic Agents (see Anticholinergic Agents)

First Generation Antihistamines (see H1-Histamine Receptor Antagonists)

• Brompheniramine: high anticholinergic activity
• Carbinoxamine: high anticholinergic activity
• Chlorpheniramine: high anticholinergic activity
• Clemastine: high anticholinergic activity
• Cyproheptadine: high anticholinergic activity
• Dimenhydrinate: high anticholinergic activity
• Diphenhydramine (Benadryl) (see Diphenhydramine): high anticholinergic activity
• Doxylamine: high anticholinergic activity
• Hydroxyzine (Atarax, Vistaril) (see Hydroxyzine): high anticholinergic activity
• Meclizine (Bonine, Bonamine, Antivert, Postafen, Sea Legs, Dramamine) (see Meclizine): high anticholinergic activity
• Triprolidine: high anticholinergic activity

Second-Generation Antihistamines (see H1-Histamine Receptor Antagonists)

• Cetirizine (Zyrtec) (see Cetirizine): variable anticholinergic activity
• Loratidine (Claritin) (see Loratidine): low anticholinergic activity

Third-Generation Antihistamines (see H1-Histamine Receptor Antagonists)

• Desloratadine (Clarinex) (see Desloratadine): low anticholinergic activity
• Fexofenadine (Allegra, Axodin) (see Fexofenadine): low anticholinergic activity
• Levocetirizine (Xyzal) (see Levocetirizine): low anticholinergic activity

Anti-Parkinson’s Medications

• Amantadine (Symmetrel, Symadine) (see Amantadine): low anticholinergic activity
• Benztropine (Cogentin) (see Benztropine): high anticholinergic activity
• Bromocriptine (Parlodel, Cycloset, Brotin) (see Bromocriptine): low anticholinergic activity
• Entacapone (Comtan, Stalevo): low anti-cholinergic activity
  • Trihexyphenidyl (Artane) (see Trihexyphenidyl): high anticholinergic activity

Opiates (see Opiates)

• Codeine (see Codeine): low anticholinergic activity
• Fentanyl (see Fentanyl): low anticholinergic activity
• Hydrocodone (see Hydrocodone): low anticholinergic activity
• Meperidine (see Meperidine): low anticholinergic activity
• Methadone (see Methadone): low anticholinergic activity
• Morphine (see Morphine): low anticholinergic activity
• Oxycodone (see Oxycodone): low anticholinergic activity
• Tramadol (see Tramadol): low anticholinergic activity

Antimuscarinic Agents

Antimuscarinic Medications for Overactive Bladder

• Darifenacin: high anti-cholinergic activity
• Fesoterodine (Toviaz) (see Fesoterodine): high anticholinergic activity
• Oxybutynin (Ditropan) (see Oxybutynin): high anticholinergic activity
• Solifenacin (Vesicare) (see Solifenacin): high anticholinergic activity
• Tolterodine (Detrol, Detrusitol) (see Tolterodine): high anticholinergic activity
• Trospium: high anticholinergic activity

Antimuscarinic Spasmolytic Medications

• Atropine (see Atropine): high anticholinergic activity
• Clidinium-Chlordiazepoxide: high anticholinergic activity
• Hyoscyamine: high anticholinergic activity
• Glycopyrrolate (Robinul) (see Glycopyrrolate): high anticholinergic activity
• Homatropine: high anticholinergic activity
• Methscopolamine: high anticholinergic activity
• Scopolamine (Hyoscine) (see Scopolamine): high anticholinergic activity
• Propantheline: high anticholinergic activity

Antimuscarinic Inhaled Bronchodilators

• Ipratropium Bromide (see Ipratropium Bromide): high local anticholinergic activity
• Tiotropium (Spiriva) (see Tiotropium): high local anticholinergic activity

Antimuscarinic Ophthlamic Medications (Mydriatic/Cycloplegic)

• Atropine (see Atropine): high local anticholinergic activity
• Cyclopentolate: high local anticholinergic activity
• Homatropine (see Homatropine): high local anticholinergic activity
• Scopolamine (see Scopolamine): high local anticholinergic activity

Cardiovascular Medications

• Disopyramide (Norpace) (see Disopyramide): low anticholinergic activity

Gastrointestinal Medications

Anti-Emetics

• Hydroxyzine (Atarax, Vistaril) (see Hydroxyzine): high anticholinergic activity
• Meclizine (Bonine, Bonamine, Antivert, Postafen, Sea Legs, Dramamine) (see Meclizine, [[Meclizine]]): high anticholinergic activity
• Promethazine (Phenergan) (see Promethazine): high anticholinergic activity
• Scopolamine (see Scopolamine): high anticholinergic activity
• Prochlorperazine (Compazine) (see Prochlorperazine): low anticholinergic activity

Other

• Domperidone (see Domperidone): low anticholinergic activity
• Loperamide (see Loperamide): low anticholinergic activity
• H2-Blockers (see H2-Histamine Receptor Antagonists, [[H2-Histamine Receptor Antagonists]])
  • Cimetidine (Tagamet) (see Cimetidine): low anticholinergic activity
  • Famotidine (Pepcid) (see Famotidine): low anticholinergic activity
  • Ranitidine (Zantac) (see Ranitidine): low anticholinergic activity

Muscle Relaxants

• Orphenazine: high anticholinergic activity
• Tizanidine (xxx) (see Tizanidine): high anticholinergic activity
• Cyclobenzaprine (xxx): variable anticholinergic activity
• Baclofen (xxx) (see Baclofen): low anticholinergic activity
• Methocarbamol (Robaxin) (see Methocarbamol): low anticholinergic activity

Psychotropic/Neurologic Medications

Benzodiazepines (see Benzodiazepines)

• Chlordiazepoxide (Librium) (see Chlordiazepoxide): low anticholinergic activity
• Clonazepam (Klonopin, Rivotril, Clonotril) (see Clonazepam): low anticholinergic activity
• Temazepam (Restoril, Normison) (see Temazepam): low anticholinergic activity
• Triazolam (Halcion) (see Triazolam): low anticholinergic activity

First-Generation Antipsychotics

• Chlorpromazine (see Chlorpromazine): high anticholinergic effect
• Fluphenazine (see Fluphenazine): high anticholinergic effect
• Haloperidol (Haldol) (see Haloperidol): low anticholinergic effect
• Loxapine (see Loxapine): high anticholinergic effect
• Methotrimeprazine (Levomepromazine): high anticholinergic effect
• Perphenazine: variable anticholinergic effect
• Thioridazine (see Thioridazine): high anticholinergic activity
• Trifluoperazine: high anti-cholinergic activity

Second-Generation Antipsychotics

• Clozapine (Clozaril) (see Clozapine): high anticholinergic activity
• Olanzapine (Zyprexa) (see Olanzapine): variable anticholinergic activity
• Quetiapine (Seroquel) (see Quetiapine): low anticholinergic activity
• Iloperidone: low anticholinergic activity
• Risperidone (Risperdal) (see Risperidone): low anticholinergic activity

Selective Serotonin Uptake Inhibitors (SSRI’s)

• Citalopram (Celexa) (see Citalopram): low anticholinergic activity
• Fluoxetine (Prozac) (see Fluoxetine): low anticholinergic activity
• Fluvoxamine (Luvox) (see Fluvoxamine): low anticholinergic activity
• Paroxetine (Paxil) (see Paroxetine): variable anticholinergic activity

Tricyclic Antidepressants (see Tricyclic Antidepressants)

• Amitriptyline (see Amitriptyline): high anticholinergic activity
• Clomipramine (see Clomipramine): high anticholinergic activity
• Desipramine (see Desipramine): high anticholinergic activity
• Doxepin (see Doxepin): high anticholinergic effect
• Imipramine (see Imipramine): high anticholinergic activity
• Nortriptyline (see Nortriptyline): high anticholinergic activity

Other

• Carbamazepine (Tegretol) (see Carbamazepine): low anticholinergic activity
• Lithium (see Lithium): low anticholinergic activity
• Nefazodone (see Nefazodone): low anticholinergic activity
• Oxcarbazepine (see Oxcarbazepine): low anticholinergic activity
• Phenelzine (see Phenelzine): low anticholinergic activity
• Trazodone (see Trazodone): low anticholinergic activity

Plants/Herbs

• Angel’s Trumpet (Brugmansia Species)
• Henbane (Hyoscyamus Niger)
• Jimson Weed (Datura Stramonium)
• Mandrake (Mandragora Officinarum)
• Moonflower (Datura Inoxia)
• Muscarinic Toxic Mushroom Species (see Toxic Mushrooms)
  • Clitocybe: particularly implicated
  • Inocybe: particularly implicated
  • Amanita
  • Entoloma
  • Mycena
• Nightshade Species (see Nightshade)
  • American Nightshade (Solanum Americanum)
  • Bittersweet Woody Nightshade (Solanum Dulcamara)
  • Black (Common) Nightshade (Solanum Nigrum)
  • Deadly Nightshade (Atropa Belladonna)

Diagnosis

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Clinical Manifestations

Cardiovascular Manifestations

Sinus Tachycardia (see Sinus Tachycardia)

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Dermatologic Manifestations

Dry Skin

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Neurologic Manifestations

XXXX

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Treatment

Physostigmine (see Physostigmine)

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References

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