Comparison of Cimetidine and Pirenzepine in the Healing and Maintenance of Remission in Duodenal Ulcer

Gent, A. E.; Hellier, M. D.

doi:10.1159/000200351

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Because of its receptor specificity, it has fewer and less severe unwanted peripheral effects when compared with the traditional anticholinergic hyoscyamine (Jaup et al 1980), and few psychotropic effects in dosages of 50 mg/day (Kuhn & Honzak 1980). However, in one comparative study utilising pirenzepine up to 100 mg/day, at least 2 patients withdrew because of blurred vision and an acute psychotic episode, respectively, which may be attributed to anticholinergic effects (Gent & Hellier 1990). …”

Section: Antispasmodic/antisecretory Agentsmentioning

confidence: 99%

The Problems of Anticholinergic Adverse Effects in Older Patients

1993

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The old saying 'red as a beet, dry as a bone, blind as a bat, hot as a hare, mad as a hatter' is often quoted when describing the autonomic effects of drugs that block the muscarinic cholinergic system. These effects may be subtle or dramatic, yet can be overlooked or discounted as a natural consequence of old age. Elderly patients can be particularly sensitive to the anticholinergic action of drugs because of physiological and pathophysiological changes that often accompany the aging process. The use of multiple drugs, a common finding in older patients, may result in pharmacodynamic and pharmacokinetic drug interactions that heighten anticholinergic effects. While the classic anticholinergic problems of decreased secretions, slowed gastrointestinal motility, blurred vision, increased heart rate, heat intolerance, sedation and possibly mild confusion, may be uncomfortable for a younger patient in relatively good health, these effects can be disastrous for older patients. Even the most common peripheral anticholinergic complaint of dry mouth can reduce the ability to communicate, predispose to malnutrition, promote mucosal damage, denture misfit or dental caries, and increase the risk of serious respiratory infection secondary to loss of antimicrobial activity of saliva. Mydriasis and the inability to accommodate will impair near vision and may precipitate narrow angle glaucoma in predisposed patients, but less obviously could lead to an increased risk of accidents, including falls. Somatic complaints of constipation and urinary hesitancy, could, in the presence of anticholinergic challenge, result in faecal impaction or urinary retention. Cardiac effects may be poorly tolerated. Increases in heart rate may precipitate or worsen angina. Finally, thermoregulatory impairment induced by anticholinergics, which block the ability to sweat, may lead to life threatening hyperthermia. Central anticholinergic effects range from sedation, mild confusion and inability to concentration to frank delirium. Even mild effects can reduce function and increase dependency. At any level of care, the loss of independence increases the caregiver burden, costs, and most importantly, can negatively affect quality of life. Many age-related and disease-related conditions may predispose elderly patients to anticholinergic drug toxicity. Careful attention to anticholinergic effects when prescribing drugs, patient education, regular review of the entire drug regimen, and familiarity with the signs and symptoms of anticholinergic toxicity will help to reduce the risk of drug-induced problems.

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Section: Antispasmodic/antisecretory Agentsmentioning

confidence: 99%

The Problems of Anticholinergic Adverse Effects in Older Patients

1993

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“…However, combination therapy of a H 2 RA and a M1‐antagonist does not lead to higher healing rates [12,13]. Pirenzepine (2 × 50 mg day −1 ) was slightly more effective at preventing duodenal ulcer relapse than placebo [14] and was not significantly different from cimetidine [15].…”

Section: Preventing Stimulation Of the Parietal Cellmentioning

confidence: 99%

Developments in the inhibition of gastric acid secretion

Mössner

Caca

2005

Eur J Clin Investigation

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Understanding the physiology of gastric acid secretion and the pathophysiology of acidrelated diseases (e.g. gastrooesophageal reflux and peptic ulcer) has led to the development of numerous ways to decrease acid exposure. Pharmacologically one can try to neutralize secreted acid by antacids, prevent stimulation of the parietal cell, improve mucosal defences and block the functioning of the proton pump. Proton pump inhibitors (PPIs) inhibit the final step of acid secretion, and are currently the most potent acid inhibitors. Major therapeutic improvement within the PPI class appears unlikely, as agents in this class share similar chemistry, mode of action, and pharmacokinetic profiles. New approaches that block acid secretion are now being developed. Gastrin (CCK 2 ) receptor antagonists and potassium-competitive acid blockers (P-CABs) are in clinical development.Keywords Gastrin (CCK 2 ) receptor antagonist, gastrooesophageal reflux disease, H + ,K + -ATPase, H 2 -blocker, histamine (H 2 ) receptor antagonist, peptic ulcer, potassium-competitive acid blocker (P-CAB), proton pump inhibitor. Eur J Clin Invest 2005; 35 (8): 469-475

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Comparison of Cimetidine and Pirenzepine in the Healing and Maintenance of Remission in Duodenal Ulcer

Cited by 2 publications

References 8 publications

The Problems of Anticholinergic Adverse Effects in Older Patients

The Problems of Anticholinergic Adverse Effects in Older Patients

Developments in the inhibition of gastric acid secretion

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