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ALIMENTARY TRACT AND METABOLISM › DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS › DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS › Synthetic anticholinergics, quaternary ammonium compounds
propantheline
A03AB05
Adult Dosing
- Peptic ulcer: 15 mg orally 3 times daily before meals and 30 mg at night (total 75 mg/day); maintenance 15 mg twice daily
- Hyperhidrosis: 15 mg orally 3 times daily up to 30 mg 3 times daily
- Urinary incontinence/detrusor overactivity: 15 mg orally 2 to 3 times daily
Pediatric Dosing
- Safety and efficacy not established in pediatric patients
Indications
- Adjunctive treatment for peptic ulcer disease
- Control of symptoms in irritable bowel syndrome (irritable colon, spastic colon)
- Management of urinary incontinence due to detrusor overactivity
- Adjunctive management of hyperhidrosis
Mechanism of Action
- Synthetic quaternary ammonium anticholinergic agent
- Competitively blocks acetylcholine at muscarinic receptors on autonomic effector sites in smooth muscle, cardiac muscle, and secretory glands
- Decreased gastrointestinal motility, gastric acid secretion, and smooth muscle tone
- Reduces sweat gland secretion
Contraindications
- Hypersensitivity to propantheline or other anticholinergics
- Narrow-angle glaucoma
- Obstructive uropathy (e.g., bladder neck obstruction due to prostatic hypertrophy)
- Obstructive disease of the gastrointestinal tract (e.g., achalasia, pyloroduodenal stenosis)
- Paralytic ileus, intestinal atony, or severe ulcerative colitis
- Toxic megacolon
- Unstable cardiovascular status in acute hemorrhage
Adverse Reactions
- Xerostomia (dry mouth)
- Blurred vision and mydriasis
- Constipation and decreased gastric motility
- Urinary retention and hesitancy
- Tachycardia and palpitations
- Drowsiness, dizziness, and headache
- Decreased sweating leading to heat intolerance and anhidrosis
- Nausea and vomiting
Drug Interactions
- Amantadine: May potentiate anticholinergic adverse effects
- Antacids: May interfere with absorption of anticholinergic agents
- Antipsychotics (e.g., phenothiazines): Increased risk of anticholinergic side effects and reduced antipsychotic efficacy
- Digoxin: Quaternary anticholinergics may increase serum digoxin concentrations via decreased GI motility
- H2-blockers: Concomitant use may alter absorption profiles
- Other anticholinergic drugs (e.g., tricyclic antidepressants, antihistamines): Additive anticholinergic toxicity
Curated Content: Needs Vetting Before Put to Clinical Use