Cholinergic Drugs (Cholinomimetic, Parasympathomimetic)

1.Cholinergic agonists

a. Choline esters

• Acetylcholine
• Methacholine
• Carbachol
• Bethanechol

b. Alkaloids

• Muscarine
• Pilocarpine
• Arecoline

2. Anticholinesterases

a. Reversible

        i) Carbamates

• Physostigmine (Eserine)
• Neostigmine
• Pyridostigmine
• Edrophonium
• Rivastigmine
• Donepezil
• Galantamine

      ii) Acridine

• Tacrine

b. Irreversible

i) Carbamates

• Cararyl
• Propoxur

ii) Organophosphates

• Dyflos (DFP)
• Echothiophate
• Malathion
• Tabun
• Sarin
• Soman

Preparations 

1. Bethanechol: 10–40 mg oral, 2.5–5 mg s.c. UROTONIN, BETHACOL 25 mg tab. 

2. Pilocarpine: 0.5–4% topically in eye. PILOCAR 1%, 2%, 4% eye drops; 

CARPINE 0.5% eye drops; PILODROPS 2% eye drops. 

3. Physostigmine: 0.5–1.0 mg oral/i.m., 0.25–0.5% topically in eye. 

BI-MIOTIC 0.25% eye drops with 2% pilocarpine nitrate. 

4. Neostigmine: 15–30 mg oral, 0.5–2.5 mg s.c./i.m. 

PROSTIGMIN, MYOSTIGMIN, TILSTIGMIN 15 mg tab, 0.5 mg/ml in 1 ml and 5 ml inj. 

5. Pyridostigmine: 60–180 mg oral. DISTINON, MYESTIN 60 mg tab. 

6. Rivastigmine: Initially 1.5 mg BD, increase every 2 weeks by 1.5 mg/day upto 6 mg BD. EXELON, RIVAMER 1.5, 3, 4.5, 6.0 mg caps. 

7. Donepezil: 5 mg at bed time once daily (max 10 mg/day). 

DONECEPT, DOPEZIL, DORENT 5, 10 mg tabs. 

8. Galantamine: 4 mg BD (max 12 mg BD). GALAMER 4, 8, 12 mg tab