Have you ever noticed that your mouth is always dry, your eyes are a little blurry, or your stomach is always dry because of certain medications you take? You may think that this is something else caused by your illness. However, the reason for this could be that you are unknowingly taking a medicine that has anticholinergic properties. Don't worry, this is very common. Today, we will talk about this in a simple way that you can understand.
What exactly are these anticholinergic medications?
This name may sound a bit complicated. But the story is very simple. Our body's nervous system is a very amazing network. This is what controls everything from our thoughts, movements, breathing, and heartbeat. There are "messengers" in this nervous system to carry messages back and forth. Just like people delivering letters in a post office. We call these messengers `(Neurotransmitters)`.
One such very important messenger is acetylcholine .
Now let's see what the main function of this `Acetylcholine` is. There are two main parts of our autonomic nervous system.
1. Sympathetic system: This is our "fight-or-flight" system. Simply put, this system prepares us to face an emergency, fear, or threat. It's like the accelerator in a car. When it's activated, our heart beats faster, our eyes dilate, and we sweat.
2. Parasympathetic system: This is our "rest-and-digest" system. This means that this system helps the body to calm down, digest food, and relax. It is like the brakes on a car. Our messenger called `Acetylcholine` works mainly in this system.
Okay, now you understand the background of the story, right? Anticholinergic drugs work by interfering with the work of that messenger called `Acetylcholine`. That means that when that messenger goes to the place where it needs to deliver its message, that place (receptor) is blocked. Then the work of that "calming" system (Parasympathetic) is reduced a little.
Simply put, anticholinergic medications temporarily block the action of a messenger that controls the relaxing and calming processes in our body.
What kind of diseases is this medicine used for?
There are over 600 medications that have anticholinergic properties. Some medications are designed to take advantage of this anticholinergic property to treat diseases. Some medications have this property as a side effect.
In the table below, let's look at several types of medications that primarily use this anticholinergic property to treat diseases.
| Name of the medicine (example) | Use cases and a simple explanation |
|---|---|
| Atropine | This is a drug often used in the Emergency Department (ETU). It is used to treat bradycardia when the heart rate is too slow, and as a treatment for poisoning from certain pesticides. In the event of poisoning, your doctor will contact the National Poisons Information Center at the National Hospital for further advice. |
| Ipratropium / Tiotropium | These are found in inhalers given to people with respiratory diseases like asthma and COPD. These medications help widen the airways and make breathing easier. |
| Oxybutynin / Solifenacin | These are given to treat urge incontinence, a condition in which you have to urinate frequently and have difficulty controlling your flow of urine. These medications work by reducing the contraction of the muscles in the bladder. |
| Scopolamine | These are used to treat vomiting and nausea caused by traveling on buses and ships (motion sickness). They sometimes come in the form of a patch. |
| Benztropine / Trihexyphenidyl | This medication helps control symptoms such as tremors caused by Parkinson's disease. |
| Diphenhydramine | Many medications used for allergies (e.g., piritan) contain these. This anticholinergic property is the main reason why you feel sleepy and have a dry mouth when taking these. |
Medicines that have this property as a side effect
There are some medications that, although their main function is something else, have an anticholinergic effect as a side effect.
- Some older medications used to treat conditions like depression (Tricyclic antidepressants). Some medications (`Antipsychotic medications`) are given for severe mental illnesses like schizophrenia .
- Many medications for allergies (`Antihistamines`).
What are the side effects of anticholinergic medications?
Now you probably understand why these medications cause dry mouth and blurred vision. When we reduce the activity of that "calming" system, many of the things that are controlled by that system are affected.
There is an English proverb used by doctors to remember these side effects. "Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter". This means "Hot as a hare, blind as a bat, dry as a bone, red as a beetroot, mad as a hatter" . This makes it easy to remember the main side effects.
Let's take a simple look at these side effects and their causes in the table below.
| Side Effect | Simply put, what happens? |
|---|---|
| Dry mouth & eyes | The "calm" system stimulates the production of saliva and tears. When it is less active, saliva and tears are also less produced. |
| Blurred vision | The muscles that change the size of the pupil are affected, making it difficult to see things up close. The pupils become larger (dilated pupils). |
| Difficulty urinating (Urinary retention) | As the bladder muscles become less flexible, it becomes difficult to completely empty the bladder. |
| Constipation | Intestinal movement related to the digestive process slows down. |
| Rapid heartbeat (Tachycardia) | The heart rate increases above normal levels because the "brake" that controls the heartbeat is weakened. |
| Confusion / Altered mental status | Acetylcholine is also important for memory and thought processes in the brain. When it is disrupted, especially in older people, it can lead to confusion. |
| Hyperthermia & Flushed skin | Sweating is a way for the body to regulate temperature. These medications can reduce sweating, which can increase body temperature. |
What time do you need to see the doctor?
If you have been prescribed an anticholinergic medication, the benefits of taking it far outweigh the side effects. However, if you experience any of the following, be sure to talk to your doctor.
- If your illness doesn't feel better with medication.
- If you have difficulty taking the medicine as prescribed by the doctor (e.g., if you are having difficulty due to side effects).
- If the side effects of the medication are severe enough to interfere with your daily activities (going to work, driving, studying).
Imagine, you have asthma, and the inhaler you are given makes it easier to breathe, but your mouth is very dry. Or you have difficulty controlling your urine and the medicine you are given makes your vision a little blurry. In such a case, when you talk to your doctor, he or she can change the dosage of the medicine or prescribe another medicine that gives the same results.
The most important thing is, if you have a problem, do not stop taking your medication or change the dosage on your own. Always talk to your doctor and follow their advice.
Take-Home Message
- Anticholinergic medications work by blocking the action of a chemical messenger (Acetylcholine) that works in our body's "calming" system.
- This medicine is used as a treatment for a number of diseases, such as asthma, Parkinson's disease, and urinary incontinence.
- Some medications for allergies and depression also have this anticholinergic property as a side effect.
- Common side effects include dry mouth, blurred vision, upset stomach, rapid heartbeat, and confusion.
- If you are concerned about the side effects of a medication you are taking, don't be afraid to talk about it or make decisions on your own, but definitely talk to your doctor.
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