Excess of AcetylCholine causes SLUDE (salivation, lacrimation, urination, defecation, emesis) is a syndrome of pathological effects indicative of massive discharge of the parasympathetic nervous system
- Always check the BNF link here or equivalent for prescribing advice
- Usually due to exposure to nerve gases.
- Check BNF or equivalent for UpToDate prescribing advice
Mode of action
- Drugs that inhibit the
cholinesterase enzyme from breaking down acetylcholine (ACh)
- Increasing both the level and
duration of action of the neurotransmitter Acetylcholine.
- Donepezil (Aricept) Tablets and orodispersible tablets. Dosage 5-10mg daily
- Galantamine (Reminyl XL) Tablets, capsules and liquid.
Dosage 8mgs-24 mg once daily
- Rivastigmine (Exelon) Tablets and liquid. Dosage 1.5mgs - 6mgs twice daily. Transdermal patches. Dosage 4.6mg or 9.5mg once daily
Clinical Side effects
- ACh can stimulate postganglionic receptors to produce effects such as
- Salivation, lacrimation, defecation, micturition, sweating
- Miosis, bradycardia, and bronchospasm.
- Muscarine produces these effects, and hence they are referred to as muscarinic effects
- Postganglionic receptors are called muscarine receptors.
- Alzheimer Dementia and other dementias