ABSTRACT
Synthetic anticholinergic drugs (ACDs) have been the leading agents for treatment of Parkinson’s disease (PD) for decades before the introduction of L-dopa. These drugs are effective against Parkinsonian tremor and rigidity but fail to improve akinesia and postural changes. Their current indication in PD is for young patients with naïve resting tremor or tremor unresponsive to dopaminergic agents and for some selected cases of PD-associated dystonia. Their value as an adjunct medication to L-dopa therapy needs to be reassessed in view of emergence of newer anti-PD medications. Disturbing side effects, such as significant memory loss and blurred vision, limit the clinical utility of ACDs. Anticholinergic drugs should not be used in patients with close angle glaucoma, those prone to urinary retention, or the elderly with memory problems. The starting dose should be small and always increased in small increments (especially in the elderly). Slow withdrawal is also recommended so as to avoid exacerbation of Parkinsonian symptoms.
