A guide to anticholinergic medications

Anticholinergic medications are a class of drugs that block the action of acetylcholine, a type of neurotransmitter. Acetylcholine plays a key role in transmitting signals across different parts of your body — such as your brain and muscles — through your nervous system.

By blocking the effects of acetylcholine, anticholinergic drugs can have a wide range of effects on how your body functions and can treat different conditions.

These medications can have various effects depending on the specific tissue or organ they’re targeting, including:

• restoring the balance of dopamine in the brain
• relaxing smooth muscle, such as in the bladder
• reducing mucus buildup
• increasing heart rate

It’s important to note that not all anticholinergics are the same. The particular medication a doctor prescribes will depend on your condition and your overall health.

How do they work?

Acetylcholine is a neurotransmitter. This means it’s a chemical that carries messages from your brain to the rest of your body through your nerve cells and triggers muscles to react.

It gathers at the ends of your nerve cells until an electrical impulse triggers its release. It then travels into the space before the next nerve cell, called the synaptic cleft. Once it moves across this space, it can bind to cholinergic receptors.  

Anticholinergics target the cholinergic receptors, binding to them instead of acetylcholine. By preventing acetylcholine from binding, anticholinergic drugs stop the next neuron from activating.

This then stops activities such as muscle contraction. This is useful for health conditions where this causes problems, such as an overactive bladder that causes incontinence.   

The relaxation of certain muscles in the airways, gastrointestinal tract, and bladder can relieve conditions such as asthma, irritable bowel syndrome, and an overactive bladder.

Anticholinergic drugs can also reduce the production of saliva, mucus, and other secretions, which can be helpful in treating health conditions such as chronic obstructive pulmonary disorder (COPD).

This effect on saliva and mucus also makes anticholinergics helpful if you’re undergoing anesthesia during surgery, and some can also keep your heart rate stable in these cases.

What are they used for?

Doctors prescribe anticholinergic drugs for a variety of medical purposes. Both the type of medication you receive and the dosage will depend on your health and the condition you have. These drugs are only available by prescription, so it’s important to always consult the prescribing healthcare professional if you have any questions.

You may receive a prescription for anticholinergics for treating conditions such as:

• asthma
• COPD
• motion sickness
• gastrointestinal disorders
• overactive bladder, leading to incontinence

Anticholinergics commonly treat Parkinson’s disease, but they’re falling out of favor for this purpose because of the long-term side effects such as an increased dementia risk.

Healthcare professionals may also use these medications during anesthesia. This is to stop your salivary glands from producing excess saliva, but also to relax your muscles during surgery and keep your heart rate stable. These are important steps that ensure your safety during surgical procedures.

Possible side effects

Anticholinergic properties can be found in more than 600 medications. Often, this is the part of the drug responsible for any adverse sides as opposed to the treatment, but this isn’t always the case.

Side effects happen as a result of these medications due to the excessive blockage of cholinergic receptors. At low dosages, side effects that you may experience can include:

• headaches
• impaired memory
• reduced cognition
• anxiety
• insomnia

At higher doses, side effects can be more severe. These side effects may include:

• agitation
• confusion
• delirium
• seizures

Other less common but severe side effects include:

• hyperthermia (overheating)
• high or irregular heart rate
• constipation
• vomiting
• dry mouth
• difficulty urinating
• blurred or loss of vision
• inability to sweat

If you experience any side effects, they will depend on the type and dose of anticholinergic medication you’re taking. So it’s important to speak with a healthcare professional to understand how they might affect you.

If you experience unpleasant side effects, do not hesitate to seek help from the prescribing doctor. They may be able to change your dosage or find an alternative medication that doesn’t cause unpleasant side effects.

Anticholinergic drugs

A wide variety of anticholinergics are available. Some of these include the following:

• atropine (Atropen) to increase your heart rate if you experience bradycardia (a low heart rate)
• benztropine (Cogentin) and trihexyphenidyl for treating low dopamine levels and symptoms of Parkinson’s disease
• diphenhydramine (Benadryl) to increase the ease of sleep and relieve allergies
• glycopyrrolate (Glycate) for decreasing saliva levels during anesthesia and treating gastrointestinal ulcers
• ipratropium (Atrovent) for long-term treatment of shortness of breath by opening your airways
• oxybutynin (Ditropan) for treating incontinence and overactive bladder muscles

Remember, this isn’t a complete list. A doctor will be able to prescribe the right medication for your condition.

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Summary

Anticholinergics are a class of drugs that block the normal action of the neurotransmitter acetylcholine. They have a wide variety of effects, from muscle relaxation in people with asthma to reducing the activity of the salivary glands.

Healthcare professionals may prescribe these medications for COPD, overactive bladder, or even before you undergo surgery. A wide variety of medications fall under this umbrella, so healthcare professionals will be able to prescribe the right one for you.

Note that there is a risk of side effects — as with any medication — so if you notice any concerning effects, speak with the prescribing doctor.

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