Posted by yxibow on February 9, 2007, at 2:51:21
In reply to Re: Propranolol and hallucinations?, posted by munificentexegete on February 8, 2007, at 21:27:21
> anticholinergics rubbish, cause psychosis and hallucinations, not cure for akathisia google that.
Anticholinergics can cause psychosis at doses greater than the minimum effective dose. And yes, they can cause it also even at an effective dose. It depends on the person, and that is a broad generalization and I feel is not helpful for those who do take anticholinergics for a variety of things, including real parkinsons, pseudoparkinsonism, akathisia, and other EPS.
The rough order of increasing atropine like side effects would probably be Akineton (discontinued just about everywhere I think) -> Artane -> Cogentin / Benadryl. Can't tell you about procyclidine.
The psychosis caused isn't particularly violent catatonic psychosis that one associates with someone who has a psychotic disorder. Its more like chewing belladonna, because essentially they were all derived from that source originally.
One's cholinergic system (a core body component) is interrupted -- chills (or sometimes fever) can occur -- which is why if one is on them for an extended period of time they shouldn't excercise outdoors in the summer or in any area that could cause heat stroke when a heat wave hits.
Mostly the side effects are visual (real), dilated pupils ; it is contraindicated generally with people who have glaucoma, so that's something to ask one's doctor. Also antihistamine and drying effects will occur with some, this is why Artane is vital for my occasional sialorrhea due to unknown reasons, medication induced or symptom.
IV Benadryl is the fastest arrestor for akathisia in a hospital setting. I can tell you that first hand, when I took a phenothiazine (Compazine) in the ER for high fever and unstoppable vomiting from influenza. It started working and then akathisia hit, and I hit the nurse button immediately. Unfortunately they didn't give me a second dose for my ride home and I was having trouble telling the taxi driver how to get back to my apartment in college. But of course, as they say, you go to an ER and end up worse than you started sometimes (humour -- if you need an ER, use it please.)
A prudent regime of an anticholinergic, if it is not uncomfortable to the patient, I do believe is overblown from that description. And parkinsons patients, for whom they were originally developed for, who take larger doses, ramp up to them in a slow and orderly fashion so all said comments don't occur.
But, sure, its not the only choice for akathisia -- some people will respond to propranolol, some people will respond to benzodiazepines, theoretically I guess you could even respond to clonidine, but for some anticholinergics are the only choice.-- tidings
Jay
poster:yxibow
thread:730407
URL: http://www.dr-bob.org/babble/20070207/msgs/731301.html