Synthetic cholinergic blocking agents: Tropicamide, Cyclopentolate hydrochloride, Clidinium bromide, Dicyclomine hydrochloride, Glycopyrrolate

Tropicamide

Tropicamide is a cholinergic blocking agent. It works by inhibiting acetylcholine's action, a neurotransmitter responsible for stimulating the contraction of smooth muscles.

This leads to a relaxation of the smooth muscles in the eye, which results in increased pupil size. Tropicamide is used to dilate the pupil for ophthalmic examinations.

Side effects of tropicamide:

• Blurred vision
• Dry mouth
• Dizziness
• Angle-closure glaucoma and urinary retention
• Tropicamide should be used with caution in people with narrow angles and those with a history of glaucoma or urinary retention. It should also be used with caution in pregnant women and breastfeeding
• Tropicamide is available as an over-the-counter medication in the form of a 0.5% eye drop. It can also be prescribed in a higher concentration (1%) for more intensive use

Cyclopentolate hydrochloride

Cyclopentolate hydrochloride is a synthetic cholinergic blocking agent that competitively inhibits the binding of acetylcholine to muscarinic receptors. It is used to treat glaucoma and ocular hypertension and may also be used as an adjunct to general anesthesia.

• Cyclopentolate hydrochloride is administered topically as an ophthalmic solution.
• The most common side effect of Cyclopentolate hydrochloride might be mydriasis or dilation of the pupil.
• Other potential side effects include blurred vision, headache, and dry mouth.
• Cyclopentolate hydrochloride should be used with caution in patients with coronary artery disease, respiratory disease, or uncontrolled hypertension.
• Cyclopentolate hydrochloride should not be used in pregnant or breastfeeding women unless the potential benefit justifies the potential risk to the mother and child.
• Cyclopentolate hydrochloride should also be used with caution in children, as they may be more susceptible to its side effects.

Clidinium bromide

Clidinium bromide is a synthetic cholinergic blocking agent used to treat bronchospasm. It is a quaternary ammonium compound that competitively inhibits the action of acetylcholine at muscarinic receptors, which results in the relaxation of smooth muscles in the airways.

This leads to relief from bronchospasm and other symptoms of COPD.

Common side effects of clidinium bromide include:

• dry mouth
• constipation
• blurred vision
• drowsiness
• headache

Uses of clidinium bromide:
Clidinium bromide is used to relieve bronchospasm and other symptoms of COPD. It is also used to reduce the risk of gastrointestinal side effects caused by other medications.

Clidinium bromide should not be used by patients who:

• Have asthma
• Are allergic to clidinium, atropine, or other similar drugs
• Have a history of urinary retention
• Have an enlarged prostate
• Are pregnant or breastfeeding
• Have any other medical problem

Patients should also be cautious when taking clidinium bromide if they have:

• Glaucoma
• Cardiovascular disease
• Hypertension

Dicyclomine hydrochloride

Dicyclomine hydrochloride (Bentyl) is a synthetic cholinergic blocking agent used as an antispasmodic agent. A quaternary ammonium compound selectively and reversibly blocks the muscarinic acetylcholine receptors.

Dicyclomine treats functional bowel disorders like chronic constipation or IBS.

The most common adverse effects associated with dicyclomine use include:

• Dry mouth
• Dizziness
• Blurred vision,
• Drowsiness
• Constipation
• Impairment of short-term memory

Dicyclomine is contraindicated in patients with

• myasthenia gravis,
• gastric retention, or
• intestinal obstruction.

Dicyclomine hydrochloride should be used with caution in pregnant women and nursing mothers.

Dicyclomine is a pregnancy category B drug, which would not be dangerous to an unborn baby. However, dicyclomine hydrochloride should be used with caution in nursing mothers because it may be excreted in breast milk and cause side effects in a nursing infant.

Glycopyrrolate

Glycopyrrolate is a synthetic cholinergic blocking agent that competitively inhibits the action of acetylcholine at muscarinic receptors. It reduces secretions, primarily in the gastrointestinal tract, lungs, and urinary tract.

Common side effects include

• Constipation
• Dizziness
• blurred vision
• urinary retention
• dry mouth

Glycopyrrolate should be used with caution in patients with renal or hepatic impairment and those with a history of peptic ulcer disease or intestinal atony.

Glycopyrrolate is available as an oral tablet and injection. The recommended adult dosage is 1 to 2 mg given orally or intravenously every 4 to 6 hours, depending on the indication. In pediatric patients, the dosage is 0.01 to 0.02 mg/kg given orally or intravenously every 4 to 6 hours.

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