Anticholinergic Intoxication

Etiology

First Generation Antihistamines (see H1-Histamine Receptor Antagonists, [[H1-Histamine Receptor Antagonists]])

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

Second-Generation Antihistamines (see H1-Histamine Receptor Antagonists, [[H1-Histamine Receptor Antagonists]])

  • Cetirizine (Zyrtec) (see Cetirizine, [[Cetirizine]]): variable anti-cholinergic activity
  • Loratidine (Claritin) (see Loratidine, [[Loratidine]]): low anti-cholinergic activity

Third-Generation Antihistamines (see H1-Histamine Receptor Antagonists, [[H1-Histamine Receptor Antagonists]])

  • Desloratadine (Clarinex) (see Desloratadine, [[Desloratadine]]): low anti-cholinergic activity
  • Fexofenadine (Allegra, Axodin) (see Fexofenadine, [[Fexofenadine]]): low anti-cholinergic activity
  • Levocetirizine (Xyzal) (see Levocetirizine, [[Levocetirizine]]): low anti-cholinergic activity

Anti-Parkinson’s Medications

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

Opiates (see Opiates, [[Opiates]])

  • Codeine (see Codeine, [[Codeine]]): low anti-cholinergic activity
  • Fentanyl (see Fentanyl, [[Fentanyl]]): low anti-cholinergic activity
  • Hydrocodone (see Hydrocodone, [[Hydrocodone]]): low anti-cholinergic activity
  • Meperidine (see Meperidine, [[Meperidine]]): low anti-cholinergic activity
  • Methadone (see Methadone, [[Methadone]]): low anti-cholinergic activity
  • Morphine (see Morphine, [[Morphine]]): low anti-cholinergic activity
  • Oxycodone (see Oxycodone, [[Oxycodone]]): low anti-cholinergic activity
  • Tramadol (see Tramadol, [[Tramadol]]): low anti-cholinergic activity

Antimuscarinic Agents

Antimuscarinic Medications for Overactive Bladder

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

Antimuscarinic Spasmolytic Medications

  • Atropine (see Atropine, [[Atropine]]): high anti-cholinergic activity
  • Clidinium-Chlordiazepoxide: high anti-cholinergic activity
  • Hyoscyamine: high anti-cholinergic activity
  • Glycopyrrolate (Robinul) (see Glycopyrrolate, [[Glycopyrrolate]]): high anti-cholinergic activity
  • Homatropine: high anti-cholinergic activity
  • Methscopolamine: high anti-cholinergic activity
  • Scopolamine (Hyoscine) (see Scopolamine, [[Scopolamine]]): high anti-cholinergic activity
  • Propantheline: high anti-cholinergic activity

Antimuscarinic Inhaled Bronchodilators

  • Ipratropium Bromide (see Ipratropium Bromide, [[Ipratropium Bromide]]): high local anti-cholinergic activity
  • Tiotropium (Spiriva) (see Tiotropium, [[Tiotropium]]): high local anti-cholinergic activity

Antimuscarinic Ophthlamic Medications (Mydriatic/Cycloplegic)

  • Atropine (see Atropine, [[Atropine]]): high local anti-cholinergic activity
  • Cyclopentolate: high local anti-cholinergic activity
  • Homatropine (see Homatropine, [[Homatropine]]): high local anti-cholinergic activity
  • Scopolamine (see Scopolamine, [[Scopolamine]]): high local anti-cholinergic activity

Cardiovascular Medications

  • Disopyramide (Norpace) (see Disopyramide, [[Disopyramide]]): low anti-cholinergic activity

Gastrointestinal Medications

Anti-Emetics

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

Other

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

Muscle Relaxants

  • Orphenazine: high anti-cholinergic activity
  • Tizanidine (see Tizanidine, [[Tizanidine]]): high anti-cholinergic activity
  • Cyclobenzaprine: variable anti-cholinergic activity
  • Baclofen (see Baclofen, [[Baclofen]]): low anti-cholinergic activity
  • Methocarbamol (Robaxin) (see Methocarbamol, [[Methocarbamol]]): low anti-cholinergic activity

Psychotropic/Neurologic Medications

Benzodiazepines (see Benzodiazepines, [[Benzodiazepines]])

  • Chlordiazepoxide (Librium) (see Chlordiazepoxide, [[Chlordiazepoxide]]): low anti-cholinergic activity
  • Clonazepam (Klonopin, Rivotril, Clonotril) (see Clonazepam, [[Clonazepam]]): low anti-cholinergic activity
  • Temazepam (Restoril, Normison) (see Temazepam, [[Temazepam]]): low anti-cholinergic activity
  • Triazolam (Halcion) (see Triazolam, [[Triazolam]]): low anti-cholinergic activity

First-Generation Anti-Psychotics

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

Second-Generation Anti-Psychotics

  • Clozapine (Clozaril) (see Clozapine, [[Clozapine]]): high anti-cholinergic activity
  • Olanzapine (Zyprexa) (see Olanzapine, [[Olanzapine]]): variable anti-cholinergic activity
  • Quetiapine (Seroquel) (see Quetiapine, [[Quetiapine]]): low anti-cholinergic activity
  • Iloperidone: low anti-cholinergic activity
  • Risperidone (Risperdal) (see Risperidone, [[Risperidone]]): low anti-cholinergic activity

Selective Serotonin Uptake Inhibitors (SSRI’s)

  • Citalopram (Celexa) (see Citalopram, [[Citalopram]]): low anti-cholinergic activity
  • Fluoxetine (Prozac) (see Fluoxetine, [[Fluoxetine]]): low anti-cholinergic activity
  • Fluvoxamine (Luvox) (see Fluvoxamine, [[Fluvoxamine]]): low anti-cholinergic activity
  • Paroxetine (Paxil) (see Paroxetine, [[Paroxetine]]): variable anti-cholinergic activity

Tricyclic Antidepressants

  • Amitriptyline (see Amitriptyline, [[Amitriptyline]]): high anti-cholinergic activity
  • Clomipramine (see Clomipramine, [[Clomipramine]]): high anti-cholinergic activity
  • Desipramine (see Desipramine, [[Desipramine]]): high anti-cholinergic activity
  • Doxepin (see Doxepin, [[Doxepin]]): high anticholinergic effect
  • Imipramine (see Imipramine, [[Imipramine]]): high anti-cholinergic activity
  • Nortriptyline (see Nortriptyline, [[Nortriptyline]]): high anti-cholinergic activity

Other

  • Carbamazepine (Tegretol) (see Carbamazepine, [[Carbamazepine]]): low anti-cholinergic activity
  • Lithium (see Lithium, [[Lithium]]): low anti-cholinergic activity
  • Nefazodone (see Nefazodone, [[Nefazodone]]): low anti-cholinergic activity
  • Oxcarbazepine (see Oxcarbazepine, [[Oxcarbazepine]]): low anti-cholinergic activity
  • Phenelzine (see Phenelzine, [[Phenelzine]]): low anti-cholinergic activity
  • Trazodone (see Trazodone, [[Trazodone]]): low anti-cholinergic 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, [[Toxic Mushrooms]])
    • Clitocybe: particularly implicated
    • Inocybe: particularly implicated
    • Amanita
    • Entoloma
    • Mycena
  • Nightshade Species (see Nightshade, [[Nightshade]])
    • American Nightshade (Solanum Americanum)
    • Bittersweet Woody Nightshade (Solanum Dulcamara)
    • Black (Common) Nightshade (Solanum Nigrum)
    • Deadly Nightshade (Atropa Belladonna)

Diagnosis

  • Xxx

Clinical

  • Derm:
    • Dry skin
  • Neuro:
    • xxx
  • Cardiac:
    • Tachycardia

Treatment

  • Physostigmine:
  • xxx

References

  • xxx