Which medications in the drug class Anticholinergic are used in the treatment of Parkinson Disease?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Anticholinergic

Anticholinergics are commonly used as symptomatic treatment of PD, both as monotherapy and as part of combination therapy. Anticholinergic agents provide benefit for tremor in approximately 50% of patients but do not substantially improve bradykinesia or rigidity. If one anticholinergic does not work, try another.

Trihexyphenidyl

Trihexyphenidyl is indicated as an adjunct for all forms of parkinsonism (postencephalitic, arteriosclerotic, and idiopathic). It is often useful as adjuvant therapy when treating these forms of parkinsonism with levodopa.

It is a synthetic tertiary amine anticholinergic agent. It has a direct antispasmodic action on smooth muscle and has weak mydriatic, antisecretory, and positive chronotropic activities. In addition to suppressing central cholinergic activity, trihexyphenidyl may also inhibit reuptake and storage of dopamine at central dopamine receptors, thereby prolonging the action of dopamine. It is commonly used in combination with other antiparkinsonian agents. Generally, anticholinergic agents can help control tremor but are less effective for treating bradykinesia or rigidity.

Benztropine mesylate (Cogentin)

Benztropine mesylate is approved for use as an adjunct in the therapy of all forms of PD. It partially blocks striatal cholinergic receptors, and by blocking muscarinic cholinergic receptors in the CNS, benztropine reduces the excessive cholinergic activity present in parkinsonism and related states. It can also block dopamine reuptake and storage in CNS cells. In general, anticholinergic agents can help control tremor but are less effective for treating bradykinesia or rigidity.


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