1. Definition & Mechanism
Anticholinergics block muscarinic acetylcholine (M1–M5) receptors, inhibiting parasympathetic activity.
- Central effects → cognition, delirium (esp. M1 blockade)
- Peripheral effects → ↓ secretions, ↓ GI motility, bronchodilation, mydriasis, urinary retention
Mnemonic: “Hot, Dry, Blind, Red, Mad, Full”
2. Commonly Encountered Anticholinergic Drugs (Hospital-Relevant)
| Therapeutic Area | Examples |
|---|---|
| Neurology / Psychiatry | Benztropine, Trihexyphenidyl |
| Respiratory | Ipratropium, Tiotropium, Glycopyrrolate |
| GI / Antispasmodics | Dicycloverine (Dicyclomine), Hyoscine (Scopolamine) |
| Urology | Oxybutynin, Tolterodine, Solifenacin |
| Anesthesia / ICU | Atropine, Glycopyrrolate |
| Ophthalmology | Atropine, Tropicamide |
| Others with anticholinergic burden | TCAs, 1st-gen antihistamines, antipsychotics |
3. Muscarinic Receptor Selectivity (Clinical Relevance)
| Receptor | Location | Clinical Effect When Blocked |
|---|---|---|
| M1 | CNS, gastric glands | Delirium, cognitive impairment |
| M2 | Heart | Tachycardia |
| M3 | Smooth muscle, glands | Dry mouth, urinary retention, constipation, mydriasis |
| M4/M5 | CNS | Less defined (cognitive effects) |
➡ CNS penetration ↑ with tertiary amines (e.g., atropine, oxybutynin)
➡ Quaternary agents (e.g., glycopyrrolate) = minimal CNS effects4. Clinical Indications (Key Hospital Uses)
- Symptomatic bradycardia → Atropine
- COPD/asthma → Ipratropium, Tiotropium
- Extrapyramidal symptoms (EPS) → Benztropine
- Overactive bladder → Oxybutynin, Solifenacin
- Secretion control (ICU/palliative) → Glycopyrrolate, Scopolamine
- Pre-op anesthesia → Reduce secretions, prevent vagal responses
5. Adverse Effects (High-Yield)Peripheral
- Dry mouth, constipation, ileus
- Urinary retention (↑ risk in BPH)
- Tachycardia
- Hyperthermia (↓ sweating)
Central
- Confusion, agitation
- Delirium
- Hallucinations (elderly, high doses)
Dose-related and cumulative across drug classes6. Anticholinergic Burden (Very Important Clinically)
- Cumulative effect from multiple drugs
- Strong predictor of:
- Delirium
- Falls
- Cognitive decline
- Length of stay
High-risk populations
- Older adults
- ICU patients
- Dementia
- Renal impairment
Tools:
- Anticholinergic Cognitive Burden (ACB) Scale
- Beers Criteria (many anticholinergics = potentially inappropriate)
7. Contraindications & Cautions
| Condition | Risk |
|---|---|
| Narrow-angle glaucoma | ↑ IOP |
| BPH / urinary retention | Acute retention |
| Ileus / bowel obstruction | Worsening |
| Dementia | Cognitive decline |
| Myasthenia gravis | Symptom exacerbation |
8. Renal & Hepatic Considerations (General)
- Many agents require dose caution in renal impairment
- CNS effects ↑ in renal/hepatic dysfunction
- Prefer peripherally selective agents when possible
9. Toxicity & OverdoseAnticholinergic Toxidrome
- Delirium, hallucinations
- Hyperthermia
- Dry skin, mydriasis
- Tachycardia, urinary retention
Management
- Supportive care
- Physostigmine (selected cases, severe delirium, ECG monitoring required)
10. Practical Pharmacist Pearls✔ Always assess total anticholinergic load
✔ Avoid in elderly unless clearly indicated
✔ Prefer targeted or peripherally acting agents
✔ Monitor:
- Mental status
- Bowel/bladder function
- Heart rate
✔ Deprescribe when possible
11. Quick One-Line Clinical SummaryAnticholinergics are effective but high-risk medications whose cumulative burden is a major, often preventable cause of delirium, urinary retention, and falls in hospitalized patients—especially older adults.
Anticholinergic burden table, tailored for clinical & hospital pharmacists, using the Anticholinergic Cognitive Burden (ACB) scale (most widely used in inpatient practice).
ACB score
- 0 = no anticholinergic activity
- 1 = possible anticholinergic effect
- 2 = definite anticholinergic effect
- 3 = strong anticholinergic effect (high delirium/fall risk)
Clinical rule of thumb:
Total ACB ≥ 3 → ↑ risk of delirium, cognitive decline, falls, LOS, mortality.
Anticholinergic Burden Table (Drug-by-Drug)
CNS / Psychiatry
| Drug | Class | ACB | Key Clinical Notes |
|---|---|---|---|
| Benztropine | Antiparkinsonian | 3 | High delirium risk; avoid in elderly |
| Trihexyphenidyl | Antiparkinsonian | 3 | Strong central effects |
| Amitriptyline | TCA | 3 | Avoid in geriatrics (Beers) |
| Imipramine | TCA | 3 | High fall & arrhythmia risk |
| Nortriptyline | TCA | 2 | Less anticholinergic than amitriptyline |
| Paroxetine | SSRI | 1 | Most anticholinergic SSRI |
| Clozapine | Atypical antipsychotic | 1–2 | Dose-dependent |
| Quetiapine | Atypical antipsychotic | 1 | Sedation + anticholinergic load |
| Olanzapine | Atypical antipsychotic | 1 | ↑ delirium risk in elderly |
Respiratory
Urology (Overactive Bladder)
| Drug | Class | ACB | Key Clinical Notes |
|---|---|---|---|
| Oxybutynin | Antimuscarinic | 3 | Highest cognitive risk |
| Tolterodine | Antimuscarinic | 3 | Less CNS than oxybutynin |
| Solifenacin | M3-selective | 2–3 | Better tolerability |
| Darifenacin | M3-selective | 2 | Lower CNS penetration |
| Trospium | Quaternary amine | 1–2 | Preferred in elderly |
GI / Antispasmodics
ENT / Allergy
| Drug | Class | ACB | Key Clinical Notes |
|---|---|---|---|
| Diphenhydramine | 1st-gen antihistamine | 3 | Common cause of delirium |
| Chlorpheniramine | 1st-gen antihistamine | 3 | Avoid in inpatients |
| Hydroxyzine | Antihistamine | 3 | QT + anticholinergic risk |
| Loratadine | 2nd-gen antihistamine | 0 | Preferred |
| Cetirizine | 2nd-gen antihistamine | 0–1 | Mild sedation possible |
Cardiovascular / Other
| Drug | Class | ACB | Key Clinical Notes |
|---|---|---|---|
| Disopyramide | Antiarrhythmic | 3 | Avoid unless essential |
| Digoxin | Cardiac glycoside | 1 | Weak anticholinergic |
| Furosemide | Loop diuretic | 1 | Contributes to cumulative burden |
| Prednisone | Corticosteroid | 1 | Delirium risk additive |
High-Risk Combinations (Common in Hospital)
- Diphenhydramine + opioids
- Oxybutynin + antipsychotics
- Benztropine + TCAs
- Multiple ACB = 1 agents → hidden risk
Pharmacist Clinical Actions
✔ Calculate total ACB score on admission
✔ Flag ACB ≥ 3 during med reconciliation
✔ Substitute with lower-ACB alternatives
✔ Prefer quaternary agents (e.g., glycopyrrolate, trospium)
✔ Monitor delirium, urinary retention, constipation
One-Line Clinical Pearl
Anticholinergic burden is cumulative, often unrecognized, and one of the most modifiable medication-related causes of delirium in hospitalized patients.
Practical, drug-by-drug substitution recommendations to reduce anticholinergic burden, written for clinical & hospital pharmacists (geriatric, ICU, medical ward–ready).Focus: maintain indication efficacy while lowering ACB score and delirium risk.
High-Anticholinergic Drugs → Lower-Burden Alternatives
EPS / Parkinsonism
| High-ACB Drug | ACB | Preferred Substitution | Rationale / Pharmacist Notes |
|---|---|---|---|
| Benztropine | 3 | Amantadine | Less anticholinergic, effective for EPS |
| Dose reduction or PRN use | Avoid chronic scheduled use | ||
| Trihexyphenidyl | 3 | Amantadine | Lower cognitive toxicity |
Overactive Bladder
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Oxybutynin | 3 | Mirabegron | β3-agonist, no anticholinergic |
| Trospium | Quaternary amine → ↓ CNS | ||
| Tolterodine | 3 | Solifenacin | M3 selective |
| Darifenacin | Lowest CNS penetration |
Respiratory (COPD/Asthma)
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Oral anticholinergics | 2–3 | Inhaled LAMA/SAMA | ↓ systemic effects |
| Ipratropium (frequent PRN) | 1 | Tiotropium | Once-daily, better adherence |
Inhaled agents = minimal CNS penetration.
GI / Antispasmodics
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Dicycloverine | 3 | Peppermint oil | IBS symptom relief |
| Loperamide (if diarrhea) | No anticholinergic | ||
| Non-pharm strategies | Diet, fiber | ||
| Hyoscine | 3 | Ondansetron (if nausea) | Safer alternative |
Allergy / Pruritus / Sleep
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Diphenhydramine | 3 | Cetirizine / Loratadine | 2nd-gen antihistamines |
| Melatonin | Sleep aid | ||
| Low-dose trazodone | If insomnia | ||
| Hydroxyzine | 3 | Cetirizine | Same indication, safer |
Diphenhydramine is a top cause of inpatient delirium.
Depression / Anxiety
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Amitriptyline | 3 | Sertraline | First-line SSRI |
| Duloxetine | Neuropathic pain + depression | ||
| Gabapentin | Neuropathic pain | ||
| Paroxetine | 1 | Escitalopram | Lower anticholinergic |
Cardiac / Other
| High-ACB Drug | ACB | Preferred Substitution | Notes |
|---|---|---|---|
| Disopyramide | 3 | Alternative antiarrhythmic | Rarely justified |
| Prednisone (delirium) | 1 | Dose reduction / taper | Minimize exposure |
| Furosemide (polypharmacy) | 1 | Reassess indication | Hidden burden |
ICU-Specific Substitutions
| Indication | Avoid | Use Instead | Rationale |
|---|---|---|---|
| Secretion control | Atropine | Glycopyrrolate | No CNS penetration |
| Sedation | Diphenhydramine | Dexmedetomidine | ↓ delirium |
| Nausea | Scopolamine | Ondansetron | Safer |
Pharmacist-Led Deprescribing Algorithm (Quick)
- 1️⃣ Calculate total ACB score
- 2️⃣ Identify ACB = 3 drugs first
- 3️⃣ Substitute with non-anticholinergic or peripherally selective agent
- 4️⃣ Reassess cognition, bowel, bladder in 24–72 h
- 5️⃣ Document delirium risk reductionOne-Line Clinical Pearl
Replacing one ACB-3 drug often reduces delirium risk more than stopping multiple low-risk agents.
Anticholinergic Agents
| Aclidinium | An inhaled long-acting anticholinergic used as a maintenance bronchodilator in patients with chronic obstructive pulmonary disease (COPD). |
| Adiphenine | Not Annotated |
| Agmatine | Agmatine is being studied experimentally for several indications such as cardioprotection, diabetes, decreased kidney function, neuroprotection (stroke, severe CNS injuries, epilepsy, glaucoma, and neuropathic pain), and psychiatric conditions (depression, anxiety,… |
| Alcuronium | A non-depolarizing skeletal muscle relaxant similar to tubocurarine. It is used as an anesthesia adjuvant. |
| Amantadine | A medication used to treat dyskinesia in Parkinson’s patients receiving levodopa, as well as extrapyramidal side effects of medications. |
| Amitriptyline | A tricyclic antidepressant indicated in the treatment of depressive illness, either endogenous or psychotic, and to relieve depression associated anxiety. |
| Amobarbital | A barbiturate derivative used for the induction of sedation during procedures, short-term management of insomnia, and acute management of refractory tonic-clonic seizures. |
| Amoxapine | A tricyclic antidepressant used in the treatment of neurotic or reactive depressive disorders and endogenous or psychotic depression. |
| Anisotropine methylbromide | For use in conjunction with antacids or histamine H2-receptor antagonists in the treatment of peptic ulcer, to reduce further gastric acid secretion and delay gastric emptying. |
| Aprobarbital | Aprobarbital is a barbiturate derivative synthesized in the 1920s by Ernst Preiswerk. It was determined that the substance was capable of demonstrating sedative, hypnotic, and anticonvulsant effects. A primary treatment… |
| Aripiprazole | An atypical antipsychotic used in the treatment of a wide variety of mood and psychotic disorders, such as schizophrenia, bipolar I, major depressive disorder, irritability associated with autism, and Tourette’s syndrome. |
| Atracurium | A neuromuscular blocker indicated to relax muscles during mechanical ventilation under general anesthesia or intubation. |
| Atracurium besylate | A non-depolarizing neuromuscular blocker used to facilitate endotracheal intubation and relax skeletal muscles during surgery. |
| Atropine | A muscarinic antagonist used to treat poisoning by muscarinic agents, including organophosphates and other drugs. |
| Azatadine | An H1 receptor antagonist used to treat perennial and allergic rhinitis as well as eustachian tube congestion. |
| Barbital | A long-acting barbiturate that depresses most metabolic processes at high doses. It is used as a hypnotic and sedative and may induce dependence. Barbital is also used in veterinary practice… |
| Batefenterol | Batefenterol has been used in trials studying the treatment of Pulmonary Disease, Chronic Obstructive. |
| Belladonna | No therapeutic indications. |
| Benactyzine | Benactyzine is an anticholinergic drug used as an antidepressant in the treatment of depression and associated anxiety. Benactyzine is no longer widely used in medicine, although it is still a… |
| Benzatropine | An anticholinergic drug used to treat Parkinson’s disease (PD) and extrapyramidal symptoms, except tardive dyskinesia. |
| Benzilone | Not Annotated |
| Benzquinamide | Used to prevent and treat nausea and vomiting associated with anesthesia and surgery, administered intramuscularly or intravenously. |
| Bevonium | Not Annotated |
| Biperiden | A muscarinic receptor antagonist used to treat parkinsonism and control extrapyramidal side effects of neuroleptic drugs. |
| Bornaprine | An anticholinergic drug indicated in the treatment of hyperhidrosis, dyskinesia, akathisia, parkinsonism, and Parkinson’s disease. |
| Brompheniramine | A histamine H1 antagonist used to treat coughs, upper respiratory symptoms, and nasal congestion associated with allergies and the common cold. |
| Buclizine | An antihistamine and antiemetic drug for the treatment of allergy symptoms and prevention of nausea and vomiting. |
| Butabarbital | A barbiturate drug used as a sedative and hypnotic. |
| Butalbital | A barbiturate drug used for symptomatic treatment of tension-type headache in various combinations with acetaminophen, aspirin, caffeine, and codeine. |
| Butobarbital | For the treatment of insomnia. |
| Butylscopolamine | An antispasmodic and anticholinergic agent used for the symptomatic treatment of abdominal cramping and pain. |
| Camylofin | Not Annotated |
| Chlorphenoxamine | An antihistamine used as an antipruritic. |
| Chlorpromazine | A phenothiazine antipsychotic used to treat nausea, vomiting, preoperative anxiety, schizophrenia, bipolar disorder, and severe behavioral problems in children. |
| Chlorprothixene | A thioxanthene antipsychotic. |
| Cisatracurium | A skeletal muscle relaxant used to facilitate tracheal intubation, muscle relaxation in surgery, or mechanical ventilation. |
| Clidinium | A synthetic anticholinergic used to treat peptic ulcer disease, colicky abdominal pain, diverticulitis, and IBS. |
| Clozapine | An atypical or second-generation antipsychotic drug used in treatment-resistant schizophrenia and to decrease suicide risk in schizophrenic patients. |
| Cocaine | An ester local anesthetic used during diagnostic procedures and surgeries in or through the nasal cavities. |
| Cyclopentolate | An anticholinergic used to cause mydriasis and cycloplegia for diagnostic testing. |
| Cycrimine | For treatment and management of Parkinson’s disease. |
| Cyproheptadine | A combined serotonin and histamine antagonist used in the treatment of allergic symptoms, for appetite stimulation, and off-label in the treatment of serotonin syndrome. |
| Darifenacin | An M3 muscarinic receptor blocker used to treat urinary incontinence. |
| Desipramine | A tricyclic antidepressant used in the treatment of depression. |
| Desloratadine | A second generation tricyclic antihistamine used to treat seasonal and non seasonal allergic rhinitis, pruritus, and urticaria. |
| Dexetimide | A muscarinic antagonist that has been used to treat neuroleptic-induced parkinsonism. Benzetimide is the (-)-enantimorph of dexetimide. |
| Dextromethorphan | An NMDA receptor antagonist used to treat cases of dry cough. |
| Dicyclomine | An antimuscarinic agent used to treat IBS. |
| Difemerine | Not Annotated |
| Dihexyverine | Not Annotated |
| Dihydro-2-thioxo-5-((5-(2-(trifluoromethyl)phenyl)-2-furanyl)methyl)-4,6(1H,5H)-pyrimidinedione | Not Available |
| Dimetindene | A 1st generation selective H1 antagonist used topically as an antipruritic and orally to treat allergies. |
| Diphemanil | Used in the treatment of peptic ulcer, gastric hyperacidity, and hypermotility in gastritis and pylorospasm, and in the treatment of hyperhidrosis (excessive perspiration). |
| Diphenhydramine | A H1 receptor antihistamine used in the treatment of seasonal allergies, and various allergic reactions including sneezing, runny nose, itchy/watery eyes, itching of nose or throat, pruritus, urticaria, insect bites/stings, and allergic rashes. |
| Diphenidol | An antiemetic agent used for the prevention and symptomatic treatment of nausea and vomiting associated with various conditions as Meniere’s disease and surgery of the middle and inner ear. |
| Disopyramide | A class 1A antiarrhythmic agent used to treat life-threatening ventricular arrhythmias. |
| Dosulepin | A tricyclic antidepressant commonly used only in patients for whom alternative therapies are ineffective due to its toxicity potential. |
| Doxacurium | A nondepolarizing neuromuscular blocking agent used as an adjunct to general anesthesia to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgical procedures. |
| Doxepin | A psychotropic agent used for the treatment of depression, anxiety, manic-depressive disorder, and insomnia. |
| Doxylamine | An antihistamine used to treat insomnia and allergy symptoms and is used with pyridoxine in the treatment of nausea and vomiting in pregnancy. |
| Emepronium | Not Annotated |
| Emetonium iodide | Not Annotated |
| Escitalopram | A selective serotonin re-uptake inhibitor used in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and other select psychiatric disorders such as obsessive-compulsive disorder (OCD). |
| Etanautine | Not Annotated |
| Etybenzatropine | Not Annotated |
| Fenoterol | A beta-2 adrenergic agonist and bronchodilator used for the symptomatic treatment of asthma. |
| Fenpiverinium | An anticholinergic agent indicated in the treatment of smooth muscle spasms. |
| Fesoterodine | An antimuscarinic agent used in the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. |
| Flavoxate | A muscarinic antagonist and spasmolytic used for the symptomatic relief of conditions associated with lack of muscle control in the bladder, such as dysuria, urgency, and nocturia. |
| Fluoxetine | A selective serotonin reuptake inhibitor used to treat major depressive disorder, bulimia, OCD, premenstrual dysphoric disorder, panic disorder, and bipolar I. |
| Flupentixol | A thioxanthene neuroleptic used to treat schizophrenia and depression. |
| Gallamine | Not Annotated |
| Gallamine triethiodide | A nondepolarizing nerve blocker used in addition to anesthesia to cause skeletal muscle relaxation. |
| Gantacurium | Investigated for use/treatment in anesthesia (unspecified). |
| Glycopyrronium | An anticholinergic agent used to treat hyperhidrosis, severe drooling, COPD, used with other medications to treat ulcers, and used in anesthesia. |
| Heptabarbital | Used mainly for sedation and hypnosis. |
| Hexafluronium | Used as an adjunct with succinylcholine (or suxamethonium chloride) to prolong muscle relaxation and to prevent succinylcholine-induced muscle fasciculations. |
| Hexamethonium | A nicotinic cholinergic antagonist often referred to as the prototypical ganglionic blocker. It is poorly absorbed from the gastrointestinal tract and does not cross the blood-brain barrier. It has been… |
| Hexobarbital | For the induction of anesthesia prior to the use of other general anesthetic agents and for induction of anesthesia for short surgical, diagnostic, or therapeutic procedures associated with minimal painful… |
| Hexocyclium | The World Health Organization classifies hexocyclium as a drug for functional gastrointestinal disorders . Like other anti-muscarinic agents, hexocyclium was likely used to treat peptic ulcers or diarrhea. |
| Homatropine | An anticholinergic agent used to dilate the pupil, treat inflammation of the uveal tract, and suppress a cough. |
| Homatropine methylbromide | A muscarinic receptor antagonist used to treat peptic ulcers, gastric ulcers, and duodenal ulcers. |
| Homidium | Homidium is a group II compound with trypanocidal effects. |
| Hyoscyamine | An anticholinergic indicated to treat functional gastrointestinal disorders, biliary and renal colic, and acute rhinitis. |
| Imidafenacin | An antispasmodic with anticholinergic effects used to reduce urinary frequency. |
| Imipramine | A tricyclic antidepressant indicated for the treatment of depression and to reduce childhood enuresis. |
| Ipratropium | An anticholinergic drug used in the control of symptoms related to bronchospasm in chronic obstructive pulmonary disease (COPD). |
| Isoflurane | An inhaled general anesthetic used in surgery. |
| Isopropamide | A long-acting anticholinergic drug used to relieve symptoms of spastic and painful symptoms of gastrointestinal conditions and symptoms of flu, colds, and related conditions. |
| Lamotrigine | A phenyltriazine antiepileptic used to treat some types of epilepsy and bipolar I disorder. |
| Levacetylmethadol | For the treatment and management of opiate dependence. It is sometimes used to treat severe pain in terminal patients. |
| Maprotiline | A tetracyclic antidepressant used to treat depressive illness, major depressive disorder, bipolar disorder, and anxiety associated with depression. |
| Mazaticol | Not Annotated |
| Mebeverine | An antispasmodic used for the symptomatic treatment of stomach pain and spasms associated with irritable bowel syndrome and other gastrointestinal illnesses. |
| Mecamylamine | A nicotine antagonist used to treat moderate to severe essential hypertension and uncomplicated malignant hypertension. |
| Meclizine | A histamine H1 antagonist used to treat nausea, vomiting, and dizziness associated with motion sickness. |
| Mepenzolate | A postganglionic parasympathetic inhibitor that was previously approved for improving the healing of gastric ulcers, but has been discontinued. |
| Methadone | An opioid analgesic indicated for management of severe pain that is not responsive to alternative treatments. Also used to aid in detoxification and maintenance treatment of opioid addiction. |
| Methantheline | For the treatment of peptic ulcer disease, irritable bowel syndrome, pancreatitis, gastritis, biliary dyskinesia, pylorosplasm, and reflex neurogenic bladder in children. |
| Metharbital | Metharbital is used for the treatment of epilepsy. |
| Methotrimeprazine | A phenothiazine used in the management of psychosis, particular those of schizophrenia, and manic phases of bipolar disorder. |
| Methscopolamine | Methscopolamine is a quaternary ammonium derivative of scopolamine and antagonist at muscarininc (mACh) receptors. Methscopolamine bromide is the most common form of the active ingredient in oral pharmaceutical products. The… |
| Methscopolamine bromide | A muscarinic antagonist used to treat peptic ulcers, nausea, vomiting, and motion sickness. |
| Methylphenobarbital | For the relief of anxiety, tension, and apprehension, also used as an anticonvulsant for the treatment of epilepsy. |
| Metixene | Used for the symptomatic treatment of parkinsonism. |
| Metocurine | Metocurine is a muscle relaxant. |
| Metocurine iodide | For use as an anesthesia adjunct to induce skeletal muscle relaxation and to reduce the intensity of muscle contractions in convulsive therapy. |
| Mivacurium | A short-acting non-depolarizing neuromuscular blocking agent used to induce anesthesia during intubation and promote skeletal muscle relaxation during surgery or mechanical ventilation. |
| Nicardipine | A calcium channel blocker used for the short-term treatment of hypertension and chronic stable angina. |
| Nortriptyline | A tricyclic antidepressant used in the treatment of depression. |
| Olanzapine | An antipsychotic drug used in the management of schizophrenia, bipolar 1 disorder, and agitation associated with these disorders. |
| Orphenadrine | A muscarinic antagonist used as an adjunct for the symptomatic relief of musculoskeletal pain and discomfort. |
| Otilonium | A spasmolytic medication used to treat irritable bowel syndrome (IBS). |
| Oxitropium | Oxitropium has been investigated for the treatment of Pulmonary Disease, Chronic Obstructive. |
| Oxybutynin | An antimuscarinic agent that reduces detrusor muscle activity, relaxing the bladder and preventing the urge to void. |
| Oxyphencyclimine | A drug used to treat smooth muscle spasticity. |
| Oxyphenonium | For the treatment of visceral spasms |
| Pancuronium | A neuromuscular blocker used as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. |
| Paroxetine | A selective serotonin reuptake inhibitor used to treat major depressive disorder, panic disorder, OCD, social phobia, generalized anxiety disorder, the vasomotor symptoms of menopause, and premenstrual dysphoric disorder. |
| Penthienate | Not Annotated |
| Pentobarbital | A barbiturate drug used to induce sleep, cause sedation, and control certain types of seizures. |
| Pentolinium | Used to produce controlled hypotension during surgical procedures and in hypertensive crises. |
| Phenglutarimide | Not Annotated |
| Phenobarbital | A long-lasting barbiturate and anticonvulsant used in the treatment of all types of seizures, except for absent seizures. |
| Pipecuronium | A nondepolarizing neuromuscular blocking agent used to relax muscles during anesthesia and surgical procedures. |
| Pipenzolate | An antimuscarinic agent indicated in the treatment of gastrointestinal motility disorders and arrhythmia. |
| Piperidolate | Not Annotated |
| Pirenzepine | An antimuscarinic agent used to treat peptic ulcers, gastric ulcers, and duodenal ulcers. |
| Pizotifen | A serotonin and tryptamine antagonist indicated for migraine prophylaxis. |
| Poldine | Not Annotated |
| Prifinium | Prifinium is an antimuscarinic agent with antispasmodic and antiemetic properties. It may be useful for the treatment of irritable bowel syndrome . |
| Primidone | An antiepileptic used to treat grand mal, psychomotor, and focal epileptic seizures. |
| Procaine | A local anesthetic used for anesthesia, peripheral nerve block, and spinal nerve block. |
| Procyclidine | An antispasmodic drug used to treat parkinsonism of various types and in the treatment of extrapyramidal symptoms. |
| Profenamine | An antidyskinetic phenothiazine used to treat the symptoms of Parkinson’s disease. |
| Promazine | A phenothiazine used to manage schizophrenia. |
| Promethazine | A first-generation antihistamine used for the treatment of allergic conditions, nausea and vomiting, and motion sickness. |
| Propantheline | An antimuscarinic agent used to treat urinary incontinence, hyperhidrosis, as well as cramps and spasms of the stomach, intestines, and bladder. |
| Propiomazine | Propiomazine is largely used for its antihistamininc sleep inducing effects in treating insomnia. |
| Propiverine | An antimuscarinic agent used to treat urinary incontinence or increased urinary frequency or urgency. |
| Quetiapine | A psychotropic agent used for the management of bipolar disorder, schizophrenia, and major depressive disorder. |
| Quinidine | A medication used to restore normal sinus rhythm, treat atrial fibrillation and flutter, and treat ventricular arrhythmias. |
| Rapacuronium | A nondepolarizing neuromuscular blocking agent used as an adjunct to general anesthesia to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgical procedures. |
| Revefenacin | An anticholinergic agent used to treat COPD. |
| Rociverine | An antispasmodic indicated in the treatment of urinary, gastrointestinal, and biliary tract spasms. |
| Rocuronium | A vecuronium analog used to facilitate tracheal intubation and to relax skeletal muscles during surgery. |
| Scopolamine | A belladonna alkaloid with anticholinergic effects indicated for the treatment of nausea and vomiting associated with motion sickness and postoperative nausea and vomiting (PONV). |
| Secobarbital | A barbiturate used for the short-term treatment of insomnia. |
| Solifenacin | A muscarinic antagonist with antispasmodic properties used to treat urge urinary incontinence, urgency, and urinary frequency associated with an overactive bladder. |
| Talbutal | For use as a sedative and hypnotic. |
| Terfenadine | An antihistamine for the treatment of allergy symptoms. |
| Thiopental | A barbiturate used to induce general anesthesia, treat convulsions, and reduce intracranial pressure. |
| Thonzylamine | Thozylamine is indicated for use in the symptomatic control of allergic rhinitis or other upper respiratory allergic symptoms [FDA Label]. It is typically a part of combination over the counter… |
| Tiemonium iodide | Not Annotated |
| Timepidium | Not Annotated |
| Tiotropium | A long-acting bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). |
| Tolterodine | A muscarinic receptor antagonist used to treat overactive bladder with urinary incontinence, urgency, and frequency. |
| Tramadol | A centrally-acting opioid agonist and SNRI (serotonin/norepinephrine reuptake inhibitor) used for the management of moderate to severe pain in adults. |
| Tridihexethyl | Used as an adjunct in the treatment of peptic ulcer disease and in Acquired nystagmus |
| Triflupromazine | Used mainly in the management of psychoses. Also used to control nausea and vomiting. |
| Trihexyphenidyl | An antispasmodic drug used as an adjunct drug in the management of parkinsonism and as a treatment for extrapyramidal symptoms caused by drugs affecting the central nervous system (CNS). |
| Trimebutine | A spasmolytic agent used for the symptomatic treatment of irritable bowel syndrome (IBS) and treatment of postoperative paralytic ileus following abdominal surgery. |
| Trimethaphan | For the controlled reduction of blood pressure during surgery and in the treatment of hypertensive emergencies. |
| Tropatepine | Tropatepine has been used in France for its antiparkinsons activities . |
| Tropicamide | A muscarinic receptor antagonist used to induce mydriasis and cycloplegia for diagnostic procedures. |
| Trospium | An antimuscarinic agent used to treat the symptoms of overactive bladder (OAB). |
| Tubocurarine | Tubocurarine is a non-depolarizing neuromuscular blocking agent and the first identified curare alkaloid. Curare is one of the names used to describe plant-derived poisons used by indigenous South Americans to… |
| Umeclidinium | A long-acting muscarinic antagonist used as a long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD). |
| Vecuronium | A nondepolarizing neuromuscular blocking agent used to relax muscles or as an adjunct in general anesthesia during surgical procedures. |
| Viloxazine | A selective norepinephrine reuptake inhibitor indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults in children. |
| Ziprasidone | An atypical antipsychotic used to manage schizophrenia, bipolar mania, and agitation in patients with schizophrenia. |