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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by KaraS on March 8, 2005, at 16:20:53
Is bethanechol able to negate or counter all of the anticholinergic effects of a tricyclic AD? I've heard of it being used to counter dry mouth but am wondering how effective it is at countering the other anticholinergic effects. I'm also wondering why it isn't used more often. Does it have bad side effects of its own or is it fairly well tolerated by most people?
Posted by Sarah T. on March 8, 2005, at 19:35:32
In reply to TCA plus bethanechol?, posted by KaraS on March 8, 2005, at 16:20:53
Hi Kara. I think bethanechol is a pretty safe drug. I used it with several TCA's, primarily maprotiline. Although maprotiline was reputed to have fewer anticholingergic effects, it turned out to be much worse for me than any other TCA as far as constipation, urinary retention and dry mouth. All of the other TCA's had bad anticholinergic effects, but their adverse effects seemed to diminish with time. That did not happen with Ludiomil, perhaps because of what Steven Stahl refers to as the "pseudo-anticholinergic effect" produced by highly noradrenergic medications. The idea behind his theory is that the parasympathetic nervous system attempts to counteract the sympathetic stimulation caused by all that excess norepinephrine. I thought bethanechol was helpful. It was particularly helpful for constipation if I took it on an empty stomach first thing in the morning. My main concern was urinary retention, however, because that can be dangerous. Bethanechol helped counteract most of the urinary retention, but I think I had to take it several times a day. It's been a long time and I don't remember the dose.
Posted by KaraS on March 8, 2005, at 19:49:28
In reply to Re: TCA plus bethanechol? » KaraS, posted by Sarah T. on March 8, 2005, at 19:35:32
> Hi Kara. I think bethanechol is a pretty safe drug. I used it with several TCA's, primarily maprotiline. Although maprotiline was reputed to have fewer anticholingergic effects, it turned out to be much worse for me than any other TCA as far as constipation, urinary retention and dry mouth. All of the other TCA's had bad anticholinergic effects, but their adverse effects seemed to diminish with time. That did not happen with Ludiomil, perhaps because of what Steven Stahl refers to as the "pseudo-anticholinergic effect" produced by highly noradrenergic medications. The idea behind his theory is that the parasympathetic nervous system attempts to counteract the sympathetic stimulation caused by all that excess norepinephrine. I thought bethanechol was helpful. It was particularly helpful for constipation if I took it on an empty stomach first thing in the morning. My main concern was urinary retention, however, because that can be dangerous. Bethanechol helped counteract most of the urinary retention, but I think I had to take it several times a day. It's been a long time and I don't remember the dose.
Thanks, Sarah.I found maprotiline to be milder in terms of side effects but I was only taking 25 mg. to help with sleep. Just a couple more questions if you don't mind. Do you remember any side effects from the bethanechol itself? Did it manage to counter the "dumb drug" effect as well? It would be great to get my concentration and memory up to par.
Kara
Posted by zeugma on March 8, 2005, at 19:56:17
In reply to Re: TCA plus bethanechol? » KaraS, posted by Sarah T. on March 8, 2005, at 19:35:32
Although maprotiline was reputed to have fewer anticholingergic effects, it turned out to be much worse for me than any other TCA as far as constipation, urinary retention and dry mouth. All of the other TCA's had bad anticholinergic effects, but their adverse effects seemed to diminish with time. That did not happen with Ludiomil, perhaps because of what Steven Stahl refers to as the "pseudo-anticholinergic effect" produced by highly noradrenergic medications. The idea behind his theory is that the parasympathetic nervous system attempts to counteract the sympathetic stimulation caused by all that excess norepinephrine>>
Is that Stahl's idea? it would seem to me that possibly the reason the 'pseudo-anti-cholinergic' side effects are more intractable than the non-pseudo ones is because the parasympathetic nervous system does NOT compensate for muscarinic blockade by releasing excess acetylcholine, which would mitigate the constipation dry mouth etc. I did experience constipation on Strattera that was far worse than anything I got from nortriptyline.
anyway, this is an idea that I've had floating around for a while, that cholinergic blockade causes cholinergic release to compensate, analogous to the way haloperidol causes increased DA efflux to compensate for dopamine receptor blockade.
-z
Posted by Sarah T. on March 8, 2005, at 20:42:03
In reply to Re: TCA plus bethanechol? » Sarah T., posted by KaraS on March 8, 2005, at 19:49:28
Hi Kara. Sometimes I felt a little spaced out early in the day, but that may not have been because of bethanechol. It could have been from the TCA's/tetracyclics or something else altogether. As far as counteracting the dumb drug effect, well, I used it most while I was on maprotiline, and I didn't find maprotiline as "dumbing" as the other TCA's. I'm sorry, I don't think I answered your question. I do think it's worth a try, and I think it's pretty safe.
Posted by KaraS on March 8, 2005, at 20:45:59
In reply to Re: TCA plus bethanechol? » KaraS, posted by Sarah T. on March 8, 2005, at 20:42:03
Posted by Sarah T. on March 8, 2005, at 20:51:17
In reply to Re: TCA plus bethanechol? » Sarah T., posted by zeugma on March 8, 2005, at 19:56:17
Hi zeugma. I'm uncertain whether it is Stahl's original idea. He does bring it up in the chapter on norepinephrine reuptake inhibitors, such as reboxetine and straterra, both of which caused severe constipation for me, too. I think your ideas sound equally plausible. It is so refreshing to find people like you, and others here, and Stahl, who try to understand and explain these side effects, unlike the pdocs who told me that I couldn't possibly be constipated because "these drugs are not anticholinergic." I can't tell you how many pdocs I've walked out on because they refused to believe me just because they hadn't heard of a particular side effect before. Arrrggh!
Posted by Questionmark on March 9, 2005, at 20:00:31
In reply to Re: TCA plus bethanechol? » zeugma, posted by Sarah T. on March 8, 2005, at 20:51:17
This is the end of the thread.
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