의학정보 Propantheline(From BNF)

[Momo]

	BNF

Antimuscarinics

Interactions

Antimuscarinics

Antimuscarinics (formerly termed 'anticholinergics') reduce intestinal motility and may be useful in irritable bowel syndrome and in diverticular disease. Other indications of antimuscarinic drugs include arrhythmias (section 2.3.1), asthma and airways disease (section 3.1.2), motion sickness (section 4.6), parkinsonism (section 4.9.2), urinary incontinence (section 7.4.2), mydriasis and cycloplegia (section 11.5), premedication (section 15.1.3) and as an antidote to organophosphorus poisoning ( Emergency treatment of poisoning).

Antimuscarinics that are used for gastro-intestinal smooth muscle spasm include the tertiary amines atropine sulphate and dicycloverine hydrochloride (dicyclomine hydrochloride) and the quaternary ammonium compounds propantheline bromide and hyoscine butylbromide. The quaternary ammonium compounds are less lipid soluble than atropine and so may be less likely to cross the blood-brain barrier; they are also less well absorbed. Although central atropine-like side-effects, such as confusion, are thereby reduced, peripheral side-effects are common with quaternary ammonium compounds.
Propantheline bromide is indicated as an adjunct in the treatment of gastro-intestinal disorders characterised by smooth muscle spasm (including non-ulcer dyspepsia and irritable bowel syndrome); atropine sulphate is also licensed for these indications. Dicycloverine hydrochloride (dicyclomine hydrochloride) has a much less marked antimuscarinic action than atropine and may also have some direct action on smooth muscle. Hyoscine butylbromide is advocated as a gastro-intestinal antispasmodic, but it is poorly absorbed; the injection is useful in endoscopy and radiology. Atropine and the belladonna alkaloids are outmoded treatments, any clinical virtues being outweighed by atropinic side-effects.

CAUTIONS. Antimuscarinics should be used with caution (due to increased risk of side-effects) in Down's syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, pregnancy and breast-feeding. Interactions: Appendix 1 (antimuscarinics).

CONTRA-INDICATIONS. Antimuscarinics are contra-indicated in angle-closure glaucoma, myasthenia gravis (but may be used to decrease muscarinic side-effects of anticholinesterases?section 10.2.1), paralytic ileus, pyloric stenosis and prostatic enlargement.

SIDE-EFFECTS. Side-effects of antimuscarinics include constipation, transient bradycardia (followed by tachycardia, palpitations and arrhythmias), reduced bronchial secretions, urinary urgency and retention, dilatation of the pupils with loss of accommodation, photophobia, dry mouth, flushing and dryness of the skin. Side-effects that occur occasionally include confusion (particularly in the elderly), nausea, vomiting and giddiness.

	BNF

PROPANTHELINE BROMIDE

Interactions

Propantheline

Indications: symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm; urinary frequency (section 7.4.2); gustatory sweating (section 6.1.5)

Cautions: see notes above

Contra-indications: see notes above

Side-effects: see notes above

Dose: 15 mg 3 times daily at least 1 hour before meals and 30 mg at night, max. 120 mg daily; CHILD not recommended

Propantheline has no specific interaction information.

Propantheline belongs to Antimuscarinics and will have the following interactions of Antimuscarinics:
Many drugs have antimuscarinic effects; concomitant use of two or more such drugs can increase side-effects such as dry mouth, urine retention, and constipation; concomitant use can also lead to confusion in the elderly
Interactions do not generally apply to antimuscarinics used by inhalation

Amantadine	Increased antimuscarinic side-effects
Antidepressants, Tricyclic	Increased antimuscarinic side-effects
Antidepressants, Tricyclic (related)	Possibly increased antimuscarinic side-effects
Antihistamines	Increased antimuscarinic side-effects
Clozapine	Increased antimuscarinic side-effects
Disopyramide	Increased antimuscarinic effects
Domperidone	Antagonism of effect on gastro-intestinal activity
Ketoconazole	Reduced absorption of ketoconazole
Levodopa	Absorption of levodopa possibly reduced
MAOIs	Increased antimuscarinic side-effects
Metoclopramide	Antagonism of effect on gastro-intestinal activity
Nefopam	Increased antimuscarinic effects
Nitrates	Possibly reduced effect of sublingual nitrates (failure to dissolve under the tongue owing to dry mouth)
Parasympathomimetics	Antagonism of effect
Phenothiazines	Increased antimuscarinic side-effects of phenothiazines (but reduced plasma concentrations)

출처 : BNF(British National Formulary )