Anticholinergics/Antispasmodics (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For anticholinergics/antispasmodics the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to any of the natural belladonna alkaloids (atropine, belladonna, hyoscyamine, and scopolamine), or any related products. Also, tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - If you are pregnant or if you may become pregnant, make sure your doctor knows if your medicine contains any of the following:

• Atropine - Atropine has not been shown to cause birth defects or other problems in animals. However, when injected into humans during pregnancy, atropine has been reported to increase the heartbeat of the fetus.
• Belladonna - Studies on effects in pregnancy have not been done in either humans or animals.
• Clidinium - Clidinium has not been studied in pregnant women. However, clidinium has not been shown to cause birth defects or other problems in animal studies.
• Dicyclomine - Dicyclomine has been associated with a few cases of human birth defects but dicyclomine has not been confirmed as the cause.
• Glycopyrrolate - Glycopyrrolate has not been studied in pregnant women. However, glycopyrrolate did not cause birth defects in animal studies, but did decrease the chance of becoming pregnant and the newborn's chance of surviving after weaning.
• Hyoscyamine - Studies on effects in pregnancy have not been done in either humans or animals. However, when injected into humans during pregnancy, hyoscyamine has been reported to increase the heartbeat of the fetus.
• Mepenzolate - Mepenzolate has not been studied in pregnant women. However, studies in animals have not shown that mepenzolate causes birth defects or other problems.
• Propantheline - Studies on effects in pregnancy have not been done in either humans or animals.
• Scopolamine - Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding - Although these medicines may pass into the breast milk, they have not been reported to cause problems in nursing babies. However, the flow of breast milk may be reduced in some patients. The use of dicyclomine in nursing mothers has been reported to cause breathing problems in infants.

Children - Unusual excitement, nervousness, restlessness, or irritability and unusual warmth, dryness, and flushing of skin are more likely to occur in children, who are usually more sensitive to the effects of anticholinergics. Also, when anticholinergics are given to children during hot weather, a rapid increase in body temperature may occur. In infants and children, especially those with spastic paralysis or brain damage, this medicine may be more likely to cause severe side effects. Shortness of breath or difficulty in breathing has occurred in children taking dicyclomine.

Older adults - Confusion or memory loss; constipation; difficult urination; drowsiness; dryness of mouth, nose, throat, or skin; and unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of anticholinergics. Also, eye pain may occur, which may be a sign of glaucoma.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking anticholinergics/antispasmodics, it is especially important that your health care professional know if you are taking any of the following:

• Antacids or
• Diarrhea medicine containing kaolin or attapulgite or
• Ketoconazole (e.g., Nizoral) - Using these medicines with an anticholinergic may lessen the effects of the anticholinergic

• Central nervous system (CNS) depressants (medicines that cause drowsiness) - Taking scopolamine with CNS depressants may increase the effects of either medicine

• Other anticholinergics (medicine for abdominal or stomach spasms or cramps) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) - Taking anticholinergics with tricyclic antidepressants or other anticholinergics may cause an increase in the effects of the anticholinergic

• Potassium chloride (e.g., Kay Ciel) - Using this medicine with an anticholinergic may make gastrointestinal problems caused by potassium worse

Other medical problems - The presence of other medical problems may affect the use of anticholinergics/antispasmodics. Make sure you tell your doctor if you have any other medical problems, especially:

• Bleeding problems (severe) - These medicines may increase heart rate, which would make bleeding problems worse

• Brain damage (in children) - May increase the CNS effects of this medicine

• Colitis (severe) or
• Dryness of mouth (severe and continuing) or
• Enlarged prostate or
• Fever or
• Glaucoma or
• Heart disease or
• Hernia (hiatal) or
• High blood pressure (hypertension) or
• Intestinal blockage or other intestinal problems or
• Lung disease (chronic) or
• Myasthenia gravis or
• Toxemia of pregnancy or
• Urinary tract blockage or difficult urination - These medicines may make these conditions worse

• Down's syndrome - These medicines may cause an increase in pupil dilation and heart rate

• Kidney disease or
• Liver disease - Higher blood levels may occur and cause an increase in side effects

• Overactive thyroid - These medicines may further increase heart rate

• Spastic paralysis (in children) - This condition may increase the effects of the anticholinergic