OBJECT DRUGS

Cholinesterase Inhibitors:

• Donepezil (Aricept, etc.)
• Galantamine (Razadyne, etc.)
• Rivastigmine (Exelon)

PRECIPITANT DRUGS

Antispasmodics:

• Atropine (Donnatal, etc.)
• Dicyclomine (Bentyl)
• Belladonna (Bellamine)
• Clidinium (Quarzan)
• Cyclobenzaprine (Flexaril, etc.)
• Darifenacin (Enablex)
• Fesoterodine (Toviaz)
• Flavoxate (Urispas)
• Glycopyrrolate (Robinul, etc.)
• Hyoscyamine (Anaspaz, etc.)
• Methscopolamine (Pamine, etc.)
• Oxybutynin (Ditropan, etc.)
• Propantheline (Pro-Banthine)
• Solifenacin (Vesicare)
• Tolterodine (Detrol, etc.)
• Trospium (Sanctura, etc.)

Comment:

The cholinesterase inhibitors used to treat Alzheimer's dementia are cholinergic, while these antispasmodic agents are anticholinergic. Thus, one would expect that these antispasmodics would inhibit the efficacy of cholinesterase inhibitors. The clinical evidence suggests that this may occur.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Consider using an alternative to the anticholinergic antispasmodic or the cholinesterase inhibitor.
• Monitor:If the combination is used, monitor for evidence of reduced efficacy of the cholinesterase inhibitor.