The Effects of Bethanechol on Anticholinergic Side Effects of Haloperidol / 대한정신약물학회지

OBJECTIVES: Haloperidol has been widely used for treating schizophrenia with somewhat limitation due to the side effects. Some of these side effects are anticholinergic side effects such as dry mouth, constipation, urinary difficulty, blurred vision, sexual dysfunction, etc. Some kinds strategies to minimize these side effects are tried, one of which is the use of bethanechol. The authors studied the effects of bethanechol on the anticholinergic side effects of typical antipsychotics. METHODS: The subjects of this study consisted of 60 chronic schizophrenics who had used haloperidol since 4 weeks before the study and whose score of 'Askers side effects rating scale' was above 7. They were assigned evenly to three groups (placebo group, bethanechol 40mg group, bethanechol 80mg group). Benztropin had been washed out for 2 weeks before the study. The authors measured ASRS for evaluating the anticholinergic side effect and BPRS for evaluating the effects of bethanechol on the psychopathology, at baseline, the 2nd week and the 4th week from baseline, respectively. RESULTS: At baseline, the mean age of patients was 38.00(+/- 10.55) years, the mean duration of illness was 11.12(+/- 8.09) years, and the mean dosage of the haloperidol was 15.07(+/- 6.03)mg. At baseline, mean score of BFRS was 50.25(+/- 5.24), and mean score of ASRS was 9.27 (+/- 3.04). There were no significant differences of ages, duration of illness, dosage of haloperidol, scores of BPRS and ASRS among 3 groups at baseline. There were no significant changes in BPRS at the 2nd week and the 4th week as compared with baseline, and also there were no changes among groups. The total sums of ASRS showed the statistically significant changes in the 80mg group at the 2nd week and the 4th week. The 80mg group showed statistically significant changes in dry mouth, constipation and urinary difficulty dom the 2nd week, and orthostatic symptoms from the 4th week. CONCLUSION: The authors found that the use of bethanechol for the chronic schizophrenics treating with haloperidol greatly improved the anticholinergic side effects with no change in psychopathology. The 80mg group showed more significant results than the placebo group and the 40mg group, especially in dry mouth, constipation, urinary diffculty and orthostatic symptoms. The authors suggest that high doses of bethanechol decrease the anticholinergic side effects and increase the drug compliance of chronic schizophrenics with anticholinergic side effects.

Efficacy of Bethanechol in Antipsychotics Induced Anticholinergic Side Effects / 대한정신약물학회지

OBJECTIVES: This study was designed to evaluate bethanechol's efficacy in urinary difficulty, constipation, dry mouth and blurred vision and to evaluate the bethanechol's effect on psychopathology. METHODS: Thirty-two schizophrenic patients who have been treated with antipsychotics and the total score of anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5 were assigned to three group(controlled group, bethanechol 30 mg/day group, 60 mg/day group). These patients were entered on 6 weeks open trial. Anticholinergic side effects were assessed by 'Rating scale for side effect' and psychopathology by BPRS at base, 2nd week & 4th week. After 4weeks administration of bethanechol, 30 mg/day group was increase to 60 mg/day and 60 mg/day group was decreased to 30 mg/day for 2 weeks for evaluation of dose difference. And then anticholinergic side effects were reassessed at 6th week. RESULTS: There were significant correlations between blurred vision and age. There were no significant improvement of anticholinergic side effect in placebo group but significant improvement of urinary difficulty and dry mouth in 30 mg/day group and significant improvement of urinary difficulty, constipation and dry mouth in 60 mg/day group at 4th week evaluation. In the case dose up(bethanechol 30 mg/day to 60 mg/day) for 2 weeks, dry mouth was more improved. In the case of dose down (60 mg/day to 30 mg/day), the improvements of urinary difficulty and dry mouth were sustained but constipation was aggravated. There were no BPRS changes by bethanechol administration. CONCLUSION: These findings suggest that more than 30 mg/day of bethanechol made improvements in urinary difficulty, constipation, dry mouth, when the total score of Anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5, although 60 mg/day of bethanechol was more effective than 30 mg/day. Moreover bethanechol administration does not influence psychopathology.