Antimuscarinics

Vivian Imbriotis | June 19, 2026

Atropine and glycopyrrolate are both alkaloid non-selective antagonists of the muscarinic receptor (M1-M5).

A - Atropine 90% OBA, glyco poorly absorbed \(\to\) IV only

D - Atropine poorly water soluble, glyco poorly lipid soluble. Similar Vd ~2L/kg, both ~50% protein bound. Glyco cannot cross the BBB.

M - Atropine 50% hepatically metabolized \(\to\) inactive. Glyco not metabolized. Remainder excreted in urine.

E - Half-life of both is 2-4 hours, but atropine has a peripheral duration of only ~30 minutes due to redistribution to fat and CNS.

Mechanism: Both drugs block muscarinic receptors, decreasing intracellular cAMP.

Effects of both

  • Decreased airway secretions
  • Bronchdilation
  • Tachycardia
  • Urinary retention
  • Decreased gastric acid secretion, gastric emptying, intestinal motility \(\to\) constipation

CNS effects of atropine

  • Delirium, hallucinations
  • Mydriasis
  • Antiemesis