Genomes and Genes
Summary: Drugs that bind to but do not activate CHOLINERGIC RECEPTORS, thereby blocking the actions of ACETYLCHOLINE or cholinergic agonists.
- Qaseem A, Snow V, Shekelle P, Sherif K, Wilt T, Weinberger S, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147:633-8 pubmed..RECOMMENDATION 6: Clinicians should consider prescribing pulmonary rehabilitation in symptomatic individuals with COPD who have an FEV1 less than 50% predicted. (Grade: weak recommendation, moderate-quality evidence.). ..
- Pieper M, Chaudhary N, Park J. Acetylcholine-induced proliferation of fibroblasts and myofibroblasts in vitro is inhibited by tiotropium bromide. Life Sci. 2007;80:2270-3 pubmed..Tiotropium bromide may have a beneficial influence on airway remodeling processes in chronic airway diseases through antiproliferative effects on fibroblasts and myofibroblasts. ..
- Tashkin D, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359:1543-54 pubmed publisher..ClinicalTrials.gov number, NCT00144339.) ..
- Kesten S, Celli B, Decramer M, Leimer I, Tashkin D. Tiotropium HandiHaler in the treatment of COPD: a safety review. Int J Chron Obstruct Pulmon Dis. 2009;4:397-409 pubmed..The safety data review does not indicate an increased risk for death or cardiovascular morbidity during tiotropium treatment in patients with COPD. ..
- Carriere I, Fourrier Reglat A, Dartigues J, Rouaud O, Pasquier F, Ritchie K, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med. 2009;169:1317-24 pubmed publisher..Physicians should carefully consider prescription of anticholinergic drugs in elderly people, especially in the very elderly and in persons at high genetic risk for cognitive disorder. ..
- Ogale S, Lee T, Au D, Boudreau D, Sullivan S. Cardiovascular events associated with ipratropium bromide in COPD. Chest. 2010;137:13-9 pubmed publisher..We found an increased risk of CVEs associated with the use of ipratropium bromide within the past 6 months. These findings are consistent with previous concerns raised about the cardiovascular safety of ipratropium bromide. ..
- Salpeter S. Do inhaled anticholinergics increase or decrease the risk of major cardiovascular events?: a synthesis of the available evidence. Drugs. 2009;69:2025-33 pubmed publisher..It is possible that the reduction in respiratory morbidity could improve functional status and reduce adverse cardiac outcomes over time. Further studies are needed to address this important issue. ..
- Troosters T, Celli B, Lystig T, Kesten S, Mehra S, Tashkin D, et al. Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT trial. Eur Respir J. 2010;36:65-73 pubmed publisher..6 units (p<0.001) with tiotropium compared to placebo. In patients with COPD who are not on maintenance therapy, tiotropium is associated with significant benefits in disease progression. ..
- Sindi A, McIvor A. The use of inhaled anticholinergics in chronic obstructive pulmonary disease: is there cause for concern? A review of evidence from clinical trials. Pol Arch Med Wewn. 2009;119:74-8 pubmed..This provides the facts surrounding this debate and reinforces our belief in the safety of inhaled anticholinergics. ..
- Tonnel A, Perez T, Grosbois J, Verkindre C, Bravo M, Brun M. Effect of tiotropium on health-related quality of life as a primary efficacy endpoint in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3:301-10 pubmed..02 L; between-group difference: 0.10 +/- 0.03 L, p = 0.0001) and reduced exacerbations vs placebo. Maintenance treatment with tiotropium provided significant and clinically relevant improvements in HRQoL, as measured by the SGRQ. ..
- Campbell N, Boustani M, Lane K, Gao S, Hendrie H, Khan B, et al. Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. 2010;75:152-9 pubmed publisher..77, 95% CI 1.03-3.05; p = 0.04). Limiting the clinical use of definite anticholinergics may reduce the incidence of cognitive impairment among African Americans. ..
- Uusvaara J, Pitkala K, Tienari P, Kautiainen H, Tilvis R, Strandberg T. Association between anticholinergic drugs and apolipoprotein E epsilon4 allele and poorer cognitive function in older cardiovascular patients: a cross-sectional study. J Am Geriatr Soc. 2009;57:427-31 pubmed publisher..Having lower cognitive function as a group, APOE4 carriers may be more vulnerable to this undesirable effect, but a follow-up study is needed to demonstrate this. ..
- Criner G, Sharafkhaneh A, Player R, Conoscenti C, Johnson P, Keyser M, et al. Efficacy of tiotropium inhalation powder in african-american patients with chronic obstructive pulmonary disease. COPD. 2008;5:35-41 pubmed publisher..No patients in the tiotropium group experienced a COPD exacerbation compared with 12 in patients receiving placebo. Tiotropium significantly improved pulmonary function in African-American COPD patients. ..
- Wilt T, Niewoehner D, MacDonald R, Kane R. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007;147:639-53 pubmed..Long-acting inhaled therapies, supplemental oxygen, and pulmonary rehabilitation are beneficial in adults who have bothersome respiratory symptoms, especially dyspnea, and FEV1 less than 60% predicted. ..
- Bos I, Gosens R, Zuidhof A, Schaafsma D, Halayko A, Meurs H, et al. Inhibition of allergen-induced airway remodelling by tiotropium and budesonide: a comparison. Eur Respir J. 2007;30:653-61 pubmed
- Frascogna N. Physostigmine: is there a role for this antidote in pediatric poisonings?. Curr Opin Pediatr. 2007;19:201-5 pubmed..This paper reviews the anticholinergic toxidrome and pathophysiology, recent literature on the efficacy and toxicity of physostigmine, and its dosing, indications, and contraindications...
- Rudolph J, Salow M, Angelini M, McGlinchey R. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168:508-13 pubmed publisher..74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5; c statistic, 0.77). Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients. ..
- Celli B, Decramer M, Leimer I, Vogel U, Kesten S, Tashkin D. Cardiovascular safety of tiotropium in patients with COPD. Chest. 2010;137:20-30 pubmed publisher..78 (0.59-1.02), 0.82 (0.69-0.98), and 1.03 (0.79-1.35), respectively. Tiotropium was associated with a reduction in the risk of all-cause mortality, CV mortality, and CV events. ..
- Hilmer S, Mager D, Simonsick E, Cao Y, Ling S, Windham B, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167:781-7 pubmed..This pharmacologic approach provides a useful evidence-based tool for assessing the functional effect of exposure to medications in this population. ..
- Buhling F, Lieder N, Kuhlmann U, Waldburg N, Welte T. Tiotropium suppresses acetylcholine-induced release of chemotactic mediators in vitro. Respir Med. 2007;101:2386-94 pubmed..This may contribute to the decreased rate of exacerbations in COPD, which was observed in clinical trials. ..
- Ambrosino N, Foglio K, Balzano G, Paggiaro P, Lessi P, Kesten S. Tiotropium and exercise training in COPD patients: effects on dyspnea and exercise tolerance. Int J Chron Obstruct Pulmon Dis. 2008;3:771-80 pubmed..Although significant improvements were observed with perceived dyspnea, compared to placebo, the addition of tiotropium to pulmonary rehabilitation did not improve the 6MWT. ..
- Plaschke K, Thomas C, Engelhardt R, Teschendorf P, Hestermann U, Weigand M, et al. Significant correlation between plasma and CSF anticholinergic activity in presurgical patients. Neurosci Lett. 2007;417:16-20 pubmed..When patients receiving or not receiving anticholinergic medication were compared, anticholinergic activity tended to increase in blood and CSF after receiving anticholinergic medication > or =4 weeks (p>0.05). ..
- Uusvaara J, Pitkala K, Kautiainen H, Tilvis R, Strandberg T. Association of anticholinergic drugs with hospitalization and mortality among older cardiovascular patients: A prospective study. Drugs Aging. 2011;28:131-8 pubmed publisher..011). The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality. ..
- Junemann K, Hessdörfer E, Unamba Oparah I, Berse M, Brünjes R, Madersbacher H, et al. Propiverine hydrochloride immediate and extended release: comparison of efficacy and tolerability in patients with overactive bladder. Urol Int. 2006;77:334-9 pubmed..Both formulations are safe and well tolerated. The extended release formulation of propiverine is a suitable new option for the treatment of the overactive bladder. ..
- Tashkin D, Celli B, Kesten S, Lystig T, Mehra S, Decramer M. Long-term efficacy of tiotropium in relation to smoking status in the UPLIFT trial. Eur Respir J. 2010;35:287-94 pubmed publisher..63 units, p = 0.0006) and the least in IS (-0.60 units, p = 0.51), [corrected] compared with control. Tiotropium provided long-term benefits irrespective of smoking status, although differences among categories were observed. ..
- Hilleman D, Malesker M, Morrow L, Schuller D. A systematic review of the cardiovascular risk of inhaled anticholinergics in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2009;4:253-63 pubmed..Prospective, adequately powered RCTs are needed to provide more evidence for the CV safety of tiotropium. ..
- Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225-33 pubmed..Medications with anticholinergic activity negatively affect the cognitive performance of older adults. Recognizing the anticholinergic activity of certain medications may represent a potential tool to improve cognition. ..
- Singh S, Loke Y, Furberg C. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA. 2008;300:1439-50 pubmed publisher..8% of the control patients; RR, 1.73 [95% CI, 1.27-2.35]; [corrected] P < .001, I(2) = 0%). Inhaled anticholinergics are associated with a significantly increased risk of cardiovascular death, MI, or stroke among patients with COPD. ..
- Tashkin D, Celli B, Decramer M, Liu D, Burkhart D, Cassino C, et al. Bronchodilator responsiveness in patients with COPD. Eur Respir J. 2008;31:742-50 pubmed publisher..The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic bronchodilators. ..
- Hanania N, Donohue J. Pharmacologic interventions in chronic obstructive pulmonary disease: bronchodilators. Proc Am Thorac Soc. 2007;4:526-34 pubmed..Several novel bronchodilators are now in different stages of development for use alone or in combination with other agents. ..
- Mato A, Limeres J, Tomás I, Munoz M, Abuín C, Feijoo J, et al. Management of drooling in disabled patients with scopolamine patches. Br J Clin Pharmacol. 2010;69:684-8 pubmed publisher..No blood alterations were found during the study period. Scopolamine can be useful to control drooling in severely disabled patients although it requires appropriate patient selection and is not free from adverse effects. ..
- Plaschke K, Hill H, Engelhardt R, Thomas C, von Haken R, Scholz M, et al. EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit. Anaesthesia. 2007;62:1217-23 pubmed..We conclude that, in contrast to the EEG, the SAA level cannot be proposed as a tool for diagnosing delirium in ICU patients. ..
- Grimes G, Manning J, Patel P, Via R. Medications for COPD: a review of effectiveness. Am Fam Physician. 2007;76:1141-8 pubmed..Patients with severe hypoxemia (i.e., arterial oxygen pressure less than 55 mm Hg or oxygen saturation less than 88 percent) should be given continuous oxygen. ..
- Lundmark E, Stenberg A, Hägglöf B, Neveus T. Reboxetine in therapy-resistant enuresis: A randomized placebo-controlled study. J Pediatr Urol. 2016;12:397.e1-397.e5 pubmed publisher..Our experience is that this leaves more children with full response, but the evidence of this has yet to be shown. Reboxetine seems to be an alternative in the treatment of enuretic children who have not responded to standard treatment. ..
- Mishriki S, Aboumarzouk O, Graham J, Lam T, Somani B. Baseline symptom score and flow rate can predict failure of medical treatment of lower urinary tract symptoms: prospective 12-year follow-up study. Urology. 2013;81:390-4 pubmed publisher..The beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores. ..
- Hodoba D, Schmidt D. Biperiden for treatment of somnambulism in adolescents and adults with or without epilepsy: clinical observations. Epilepsy Behav. 2012;25:517-28 pubmed publisher..Evidence for efficacy and safety from randomized controlled trials is needed to confirm our preliminary observations. ..
- Butler L, Keys C, Lam J. Bladder calculus formation on the tip of a migrated disused ventriculoperitoneal shunt. J Pediatr Surg. 2013;48:E1-3 pubmed publisher..In this unique case report we discuss the formation and successful endoscopic treatment of a large stone in a neuropathic bladder on the tip of a migrated VP shunt. ..
- Beggiato S, Antonelli T, Tomasini M, Tanganelli S, Fuxe K, Schwarcz R, et al. Kynurenic acid, by targeting ?7 nicotinic acetylcholine receptors, modulates extracellular GABA levels in the rat striatum in vivo. Eur J Neurosci. 2013;37:1470-7 pubmed publisher..This effect may be relevant for a number of physiological and pathological processes involving the basal ganglia. ..
- del Valle Laisequilla C, Flores Murrieta F, Granados Soto V, Rocha González H, Reyes Garcia G. Ketorolac tromethamine improves the analgesic effect of hyoscine butylbromide in patients with intense cramping pain from gastrointestinal or genitourinary origin. Arzneimittelforschung. 2012;62:603-8 pubmed publisher..Data indicate that the oral ketorolac/hyoscine butylbromide mixture could be a better option than hyoscine butylbromide alone in the treatment of some acute intense cramping painful conditions. ..
- Ozga J, Anderson K. Reduction in delay discounting due to nicotine and its attenuation by cholinergic antagonists in Lewis and Fischer 344 rats. Psychopharmacology (Berl). 2018;235:155-168 pubmed publisher..Results from experiment 2 suggest that attenuation of nicotine's effects on delay discounting may not be specific to nAChR antagonism. ..
- Knox L, Jing Y, Fleete M, Collie N, Zhang H, Liu P. Scopolamine impairs behavioural function and arginine metabolism in the rat dentate gyrus. Neuropharmacology. 2011;61:1452-62 pubmed publisher..These findings suggest that scopolamine impairs behavioural function and alters L-arginine metabolism in the DG sub-region of the hippocampus specifically. The underlying mechanisms of it remain to be explored further. ..
- Tomita R, Sakurai K, Fujisaki S, Koshinaga T. Role of vasoactive intestinal peptide on the proximal and distal parts from the dentate line in the normal human internal anal sphincter. Hepatogastroenterology. 2012;59:2155-7 pubmed publisher..There are functional differences in the regulation of VIPergic nerves between the PIAS and DIAS. Relaxation reaction via VIPergic nerves was mainly involved in the regulation of enteric nerve responses in the PIAS. ..
- ..Electroconvulsive therapy has not been found to cause epilepsy. Patient's underlying organic condition may influence development of seizures. ..
- Verma A, Yadav R. Isolated lingual dystonia : responding to anticholinergic treatment. J Assoc Physicians India. 2011;59:526-7 pubmed..She experienced a marked improvement in her abnormal tongue movements. Primary lingual dystonia is a rare presentation. ..
- Dash V, Bawa M, Mahajan J, Kanojia R, Samujh R, Rao K. Role of gabapentin and anticholinergics in management of neurogenic bladder after repair of spina bifida - a randomized controlled study. J Pediatr Surg. 2016;51:2025-2029 pubmed publisher..It has potential application in patients with inadequate response to anticholinergics. prospective competitive treatment study - level II. ..
- Malloy C, Ritter K, Robinson J, English C, Cooper R. Pharmacological identification of cholinergic receptor subtypes on Drosophila melanogaster larval heart. J Comp Physiol B. 2016;186:45-57 pubmed publisher..These results provide evidence that both of these receptor subtypes display functional significance in regulating the larval heart's pacemaker activity. ..
- Rosman Y, Eisenkraft A, Milk N, Shiyovich A, Ophir N, Shrot S, et al. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media. Ann Intern Med. 2014;160:644-8 pubmed publisher..This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events. ..
- Nakanishi S. [Efficacy of mirabegron, a ?3-adrenergic agonist, switched from an anticholinergic agent for female patients aged over 70 years]. Hinyokika Kiyo. 2013;59:561-4 pubmed..2% of cases) and constipation (in 87.5% of cases). Thus, mirabegron is considered useful for female patients aged ?70 years who did not respond to treatment with an anticholinergic agent. ..
- Oh S, Choi E, Zhang Y, Mazgalev T. Botulinum toxin injection in epicardial autonomic ganglia temporarily suppresses vagally mediated atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:560-5 pubmed publisher..A temporary autonomic block using botulinum toxin might be a novel therapeutic option for several clinical conditions such as post-cardiac surgery AF. ..
- Soukup O, Jun D, Tobin G, Kuca K. The summary on non-reactivation cholinergic properties of oxime reactivators: the interaction with muscarinic and nicotinic receptors. Arch Toxicol. 2013;87:711-9 pubmed publisher..Even though atropine showed a much higher muscarinic antagonism, it is supposed that non-reactivation properties of oxime reactivators play a significant role in the treatment of OP poisoning. ..
- Cho M, Park J, Jeong M, Yi J, Ku J, Oh S, et al. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn. 2011;30:1343-9 pubmed publisher..Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation. ..
- Lowry E, Woodman R, Soiza R, Hilmer S, Mangoni A. Drug burden index, physical function, and adverse outcomes in older hospitalized patients. J Clin Pharmacol. 2012;52:1584-91 pubmed..Higher DBI scores on admission are independently associated with lower scores of the Barthel Index and predict length of stay among older hospitalized patients. The DBI may be useful in the acute setting to improve risk stratification. ..
- Campbell N, Perkins A, Hui S, Khan B, Boustani M. Association between prescribing of anticholinergic medications and incident delirium: a cohort study. J Am Geriatr Soc. 2011;59 Suppl 2:S277-81 pubmed publisher..This relationship needs to be established using prospective study designs with medication dispensing data to improve the performance of predictive models of delirium. ..
- Rai B, Cody J, Alhasso A, Stewart L. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2012;12:CD003193 pubmed publisher..These results should be viewed with caution in view of the different classes and varying doses of individual anticholinergics used in this review. Anticholinergics had well recognised side effects, such as dry mouth. ..
- Makowski A, Lindgren K, Locke J. Visual side effects of scopolamine/ dextroamphetamine among parabolic fliers. Aviat Space Environ Med. 2011;82:683-8 pubmed
- Basedow S, Kruse R, Bruch Gerharz D. [Hyperhidrosis of childhood and adolescence: clinical aspects and therapeutic options]. Hautarzt. 2011;62:928-34 pubmed publisher..In addition, therapy is often challenging since many treatment modalities are not approved for children. Nonetheless, there are still effective therapeutic options for children with hyperhidrosis. ..
- Sakakibara R, Tateno F, Kishi M, Tsuyuzaki Y, Uchiyama T, Yamamoto T. Pathophysiology of bladder dysfunction in Parkinson's disease. Neurobiol Dis. 2012;46:565-71 pubmed publisher..These treatments might be beneficial in maximizing the patients' quality of life. ..
- ..In turn, these may be associated with constipation and/or faecal soiling. This paper discusses these considerations in the management of NE. ..
- Koyama A, STEINMAN M, Ensrud K, Hillier T, Yaffe K. Long-term cognitive and functional effects of potentially inappropriate medications in older women. J Gerontol A Biol Sci Med Sci. 2014;69:423-9 pubmed publisher..More cautious selection of medications in older adults may reduce these potential risks. ..
- Zecchi R, Trevisani M, Pittelli M, Pedretti P, Manni M, Pieraccini G, et al. Impact of drug administration route on drug delivery and distribution into the lung: an imaging mass spectrometry approach. Eur J Mass Spectrom (Chichester). 2013;19:475-82 pubmed publisher..IMS analyses were performed using a MALDI-LTQ-Orbitrap XL. Using this technique we were able to compare different distributions of the drug depending on the method of administration. ..
- Naja M, Zmudka J, Hannat S, Liabeuf S, Serot J, Jouanny P. In geriatric patients, delirium symptoms are related to the anticholinergic burden. Geriatr Gerontol Int. 2016;16:424-31 pubmed publisher..0001) and worse health status on discharge (5.3 ± 2.7 vs 7.0 ± 1.7, P = 0.0008). Anticholinergic burden appears as a risk factor for both delirium symptoms and mortality. Prevention of delirium symptoms requires its reduction. ..
- Melvin T, Patel A. Pharmacotherapy for allergic rhinitis. Otolaryngol Clin North Am. 2011;44:727-39, x pubmed publisher..The efficacies of intranasal corticosteroids, antihistamines, combination topical therapy, leukotriene inhibitors, mast cell stabilizers, anticholinergics, mucolytics, decongestants, and anti-IgE are reviewed. ..
- Salamone G, Lombardi G, Gori S, Nahmod K, Jancic C, Amaral M, et al. Cholinergic modulation of dendritic cell function. J Neuroimmunol. 2011;236:47-56 pubmed publisher..These results support the existence of an autocrine/paracrine loop through which ACh modulates the function of DCs. ..
- Rodrigo G, Castro RodrÃguez J. What is the role of tiotropium in asthma?: a systematic review with meta-analysis. Chest. 2015;147:388-396 pubmed publisher..Major benefits were concentrated in the increase in lung function and in the case of patients with severe asthma, in the reduction of exacerbations. ..
- Sakakibara R, Tateno F, Kishi M, Tsuyusaki Y, Uchiyama T, Yamamoto T. [Neurology and the bladder: how to assess and manage neurogenic bladder dysfunction, with particular references to the neural control of micturition]. Brain Nerve. 2014;66:527-37 pubmed..Treatment of bladder dysfunctions is an important target for maximizing patients' quality of life. ..
- Meyer D, Schmid H. [Urination disorders in the man: differential diagnoses and therapy of benign prostate syndrome]. Praxis (Bern 1994). 2013;102:1237-42 pubmed publisher..Si le diagnostic d'hypertrophie bénigne de la prostate est confirmé, différentes options thérapeutiques, médicamenteuses ou chirurgicales, sont disponibles. ..
- Huang W, Chang L, Kuo T, Lin Y, Chen Y, Yang C. Impact of antipsychotics and anticholinergics on autonomic modulation in patients with schizophrenia. J Clin Psychopharmacol. 2013;33:170-7 pubmed publisher..Our results suggest that the muscarinic affinity of antipsychotics affects both sympathetic and parasympathetic modulation and that anticholinergics interact with antipsychotics to influence HRV. ..
- Ansari M, Bharti A, Kumar R, Ranjan P, Srivastava A, Kapoor R. Gabapentin: a novel drug as add-on therapy in cases of refractory overactive bladder in children. J Pediatr Urol. 2013;9:17-22 pubmed publisher..03). Gabapentin gives moderate results in children with OAB refractory to conventional anticholinergics. In general, the drug is well tolerated with fewer adverse effects. ..