USUAL DOSE. The greatest use is in the
oral form in prolonged therapy when no difficulty
in swallowing is present. It varies from 15 to as
much as 375 mg per day. The average dosage is
150 mg given over 24 hours.
Bethanechol Chloride (Urecholine,
ACTION AND USE. This drug is used for
acute postoperative and postpartum nonobstruc-
tive urinary retention and neurogenic atony of the
urinary bladder with retention.
USUAL DOSE. Orally, give 10 to 50 mg two
to four times daily; maximum dose is 120 mg.
Parenterally, SUBCUTANEOUSLY ONLY, give
Pilocarpine (Pilocar, Isopto-Carpine)
ACTION AND USE. Pilocarpine decreases
intraocular pressure in glaucoma.
USUAL DOSE. Initially, instill 1 drop into
the eye, up to six times daily. The average dose
is 1 drop two to four times daily.
Parasympatholytic Drugs (Anticholinergic
These drugs oppose the effect of impulses con-
veyed by the parasympathetic nerves. They act as
competitive inhibitors of acetylcholine; they relax
smooth muscles and inhibit secretions of duct
Atropine Sulfate (Alkaloid obtained from
ACTION AND USE. There are two major
actions: (1) On the central nervous system, it
causes an increase in respiration; and (2) on the
smooth muscles and secretory glands, it relaxes
the muscles of the intestinal tract, bronchi, ureter,
biliary ducts, and gallbladder. It inhibits glandular
secretions, causing dryness of the nose, throat,
bronchi, mouth, and skin.
Atropine has a mydriatic effect on the pupil
of the eye and causes a paralysis of accommoda-
tion. Atropine is used as a mydriatic and
cycloplegic in ophthalmology, as an anhydrotic
(checking the secretion of sweat), in large doses
as a circulatory stimulant, and as a respiratory
stimulant in certain poisonings. It is a physiologic
antidote for neostigmine, pilocarpine, nerve gases,
and other parasympathomimetics. Atropine may
be given with morphine to overcome the
respiratory depressant effects of morphine. It is
used preoperatively to reduce salivary and bron-
USUAL DOSE. For ophthalmic purposes,
instill 1 or 2 drops into the eye(s) up to three times
daily or 1 hour prior to examination. Orally and
parenterally for other indications, give 0.4 to 0.6
mg as directed by a physician.
Propantheline Bromide (Pro-Banthine)
ACTION AND USE. This drug is used as
adjunctive therapy in the treatment of peptic ulcer
by reducing the volume and the acidity of gastric
secretions. It is also used as an antispasmodic in
the treatment of intestinal spasms and in spasms
of the ureter and bladder.
USUAL DOSE. 15 mg taken 30 minutes
before meals and 30 mg at bedtime.
ACTION AND USE. Glycopyrrolate is also
used as adjunctive therapy in the treatment of pep-
tic ulcer. It is also indicated for intramuscular or
intravenous use in conjunction with anesthesia.
USUAL DOSE. Orally, give 1 mg three
times daily or 2 mg two or three times daily.
Parenterally, give 0.002 mg/pound intramus-
cularly 30 minutes to 1 hour prior to anesthesia.
These drugs stimulate the structures controlled
by the sympathetic (or adrenergic) nerves and start
adrenal medullary discharge of epinephrine. The
two main drugs, epinephrine and phenylephrine
are discussed under the vasoconstrictive drugs
earlier in this chapter.
Also called adrenergic blocking agents, these
drugs block the action of the sympathomimetic
amines or block sympathetic outflow. The
alpha-adrenergic blocking agents block the vaso-
constricting effects of epinephrine and norepine-
phrine, thereby lowering the blood pressure. The
beta-adrenergic blocking agents block the cardiac