Anticholinergic and spasm-relieving drugs

This class of drugs includes darifenacin (Enablex), dicyclomine (Antispas, Bentyl), flavoxate (Urispas), hyoscyamine (Anaspaz, Levbid, Levsin), methantheline (Banthine, Pro-Banthine), oxybutynin (Ditropan, Ditropan XL, Oxytrol), solifenacin (VESIcare), tolterodine (Detrol, Detrol LA), and trospium (Sanctura).

Anticholinergic agents may help relieve urge incontinence. (Anticholinergic means to oppose or counteract the activity of certain nerve fibers that cause the bladder to contract.) Some tricyclic antidepressants (TCAs), such as imipramine (Tofranil, Tofranil PM), have strong anticholinergic effects and may be prescribed to treat incontinence. Because the effects of newer, long-acting agents (for example, Detrol LA, Ditropan XL, Enablex, or VESIcare) last throughout the day, they need to be taken only once daily, which makes them very convenient. Additionally, the effects of Detrol and Detrol LA are mostly limited to the bladder, thus lessening the prevalence of side effects typically caused by anticholinergics.

• How anticholinergics work: Anticholinergics increase the amount of urine that the bladder can hold. These drugs also decrease the pressure associated with the urge to urinate.
  
  
• Who should not use these medications: Individuals with the following conditions should not use anticholinergics:
  
  
  • Allergy to anticholinergics
    
    
  • Poorly controlled narrow-angle glaucoma
    
    
  • Bladder or bowel obstruction
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• Use: All anticholinergics are available as tablets or capsules. The amount and number of doses per day varies, depending on the particular drug. Additionally, oxybutynin is available as a topical patch (Oxytrol) that is applied to the skin twice a week.
  
  
• Drug or food interactions: Caution must be used when taking other drugs that may produce anticholinergic effects, such as antihistamines, drugs used to treat depression or schizophrenia, and some drugs used to treat heart rhythm disturbances (may add to risk of developing side effects).
  
  
• Side effects: Common side effects include dry mouth, blurred vision, and constipation. Palpitations and tachycardia (rapid heartbeat) have been reported. The ability to sweat effectively may be decreased.
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