Muscarinic Antagonist - Comparison Table

Comparison Table

Substance Trade names Mechanism Clinical use Adverse effects
Atropine (D/L-Hyoscyamine) non-selective antagonism, CNS depression
  • in anaesthesia
  • anticholinesterase poisoning
  • bradycardia
  • antispasmodic in gastrointestinal hypermotility
  • urinary retention
  • xerostomia
  • blurred vision
Scopolamine (L-Hyoscine) Scopace, Transderm-Scop, Maldemar, Buscopan non-selective antagonism, CNS depression
  • as atropine
  • motion sickness
  • as atropine
  • sedation
Hydroxyzine Vistaril, Atarax
Ipratropium Atrovent and Apovent non-selective antagonism, without any mucociliary excretion inhibition.
  • in asthma and bronchitis
Tropicamide short acting non-selective antagonism, CNS depression
  • produce mydriasis and cycloplegia in diagnostics
  • may cause ocular hypertension
Pirenzepine M1 receptor-selective antagonist
  • inhibits gastric secretion
  • in peptic ulcer (not much anymore)
 (fewer than non-selective ones)
Diphenhydramine Benadryl, Sominex Non-selective antagonism in the central nervous system, blood vessels and smooth muscle tissues
  • for extrapyramidal symptoms from typical and atypical antipsychotic medications
  • antihistamine
  • sleep aid
  • antiparkinson agent
  • management of asthma symptoms
 *Sedation, dry mouth, constipation, urinary retention
Dimenhydrinate Dramamine Combination of diphenhydramine with a methylxanthine salt
  • motion sickness
Dicyclomine
Flavoxate Urispas
  • Urinary bladder antispasmodic
Oxybutynin Ditropan
  • overactive bladder
  • urge incontinence
Tiotropium Spiriva
  • Chronic obstructive pulmonary disease
Cyclopentolate short acting non-selective antagonism, CNS depression
  • produce mydriasis and cycloplegia in diagnostics
  • may cause ocular hypertension
Atropine methonitrate non-selective antagonism, blocks transmission in ganglia. Lacks CNS effects
  • antispasmodic in gastrointestinal hypermotility
Trihexyphenidyl/Benzhexol Artane Targets the M1 Muscarinic receptor Parkinson's disease Drug at relative dose has 83% activity of atropine, thus has the same side-effects
Tolterodine Detrusitol, Detrol
Solifenacin Vesicare Competitive muscarinic acetylcholine receptor antagonist
  • overactive bladder (OAB)
  • Urgency (urge incontinence)
Darifenacin Enablex Selective for M3 receptors Urinary incontinence Few side effects
Benzatropine Cogentin Reduces the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency. Parkinson's disease
Mebeverine Colofac, Duspatal, Duspatalin A muscolotropic spasmolytic with a strong and selective action on the smooth muscle spasm of the gastrointestinal tract, particularly of the colon.
  • Irritable bowel syndrome in its primary form (e.g. Abdominal Pain, Bloating, Constipation, and Diarrhea).
  • Irritable bowel syndrome associated with organic lesions of the gastrointestinal tract. (e.g. diverticulosis & diverticulitis, etc.).
  • skin rashes
Procyclidine Antimuscarinic
  • Drug-induced parkinsonism, akathisia and acute dystonia;
  • Parkinson disease; and
  • Idiopathic or secondary dystonia
 Overdose produces confusion, agitation and sleeplessness that can last up to or more than 24 hours. Pupils become dilated and unreactive to light. Tachycardia (fast heart beat), as well as auditory and visual hallucinations

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