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Review
. 2022 Feb 1;10(2):355.
doi: 10.3390/biomedicines10020355.

Misuse of Anticholinergic Medications: A Systematic Review

Stefania Chiappini  1   2 , Alessio Mosca  1 , Andrea Miuli  1 , Francesco Maria Semeraro  1 , Gianluca Mancusi  1 , Maria Chiara Santovito  1 , Francesco Di Carlo  1 , Mauro Pettorruso  1 , Amira Guirguis  3 , John Martin Corkery  2 , Giovanni Martinotti  1   2 , Fabrizio Schifano  2 , Massimo Di Giannantonio  1
Affiliations
Review

Misuse of Anticholinergic Medications: A Systematic Review

Stefania Chiappini et al. Biomedicines. .

Abstract

(1) Background: Over the last decade, misuse and diversion of medications has appeared to be increasingly concerning phenomena, including a range of different molecules. As current knowledge on the abuse of centrally acting anticholinergics is limited, the aim of the present study is to review the relevant published data, focusing on the following molecules: benztropine, biperiden, scopolamine, orphenadrine, and benzhexol/trihexyphenidyl (THP). (2) Methods: A systematic literature review was carried out using Pubmed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Research methods were registered on PROSPERO (CRD42021257293). (3) Results: A total of 48 articles, including case reports, surveys, and retrospective case series analyses, were included. Most articles focused on benzhexol/THP (n = 25), and benztropine (n = 4). The routes of administration were mostly oral, and macrodoses together concomitant illicit drugs, e.g., cocaine, have been recorded. Toxidromes included both physical (e.g., tachycardia, tachypnoea, dilatated pupils, dry skin, urinary retention, ataxia, etc.) and psychiatric symptoms (e.g., anxiety, agitation, delirium, etc.). Fatal outcomes were very rare but reported. (4) Conclusion: Results from the present study show that anticholinergic misusing issues are both widespread worldwide and popular. Considering the potential adverse effects associated, healthcare professionals should be vigilant and monitor eventual misusing issues.

Keywords: anticholinergic drugs; drug abuse; drug diversion; drug misuse.

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Conflict of interest statement

F.S. was a member of the UK Advisory Council on the Misuse of Drugs (ACMD; 2011–2019) and is currently a member of the EMA Advisory Board (Psychiatry). J.C. is a member of the ACMD’s Novel Psychoactive Substances and Technical Committees. G.M. has been a consultant and a speaker and has received research grants from Angelini, Doc Generici, Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Servier, and Recordati. S.C., A.M. (Alessio Mosca), F.D.C., G.M., M.P., A.Mi. (Andrea Miuli), A.G., and F.S. (Francesco Semeraro) have nothing to declare. M.D.G. has been a consultant and a speaker and has received research grants from Angelini, Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Servier, and Recordati.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
See this image and copyright information in PMC

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