From the Research
Cyclopyrolate should be avoided in clinical practice due to its anticholinergic effects, which can lead to adverse outcomes, particularly in elderly patients, and instead, alternative agents such as cyclopentolate or tropicamide should be used for eye examinations or surgeries. The use of cyclopyrolate, an anticholinergic medication, has been largely replaced by other agents with more predictable effects and better safety profiles 1. Anticholinergic medications, including cyclopyrolate, can cause a range of adverse effects, from mild to severe, including dry mouth, nausea, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia, and neurologic impairment such as confusion, agitation, and coma 2. In elderly patients, the use of anticholinergic medications can increase the risk of functional and cognitive decline, morbidity, institutionalization, and mortality 1. Therefore, minimizing anticholinergic burden is essential in clinical practice to improve short-term memory, confusion, and delirium, quality of life, and daily functioning 1. When anticholinergic eye drops are needed, ophthalmologists typically use cyclopentolate 0.5-2% or tropicamide 0.5-1% instead, which have more predictable effects and better safety profiles 3. These medications typically take effect within 20-45 minutes and can last several hours, with side effects including temporary blurry vision, light sensitivity, stinging upon application, and rarely, systemic effects such as dry mouth, flushing, and confusion, particularly in elderly patients or young children 4. In summary, the use of cyclopyrolate is not recommended due to its potential adverse effects, and alternative agents should be used instead. Key points to consider when using anticholinergic medications include:
- Minimizing anticholinergic burden to reduce adverse effects
- Using alternative agents with more predictable effects and better safety profiles
- Monitoring patients for adverse effects, particularly in elderly patients
- Considering the potential risks and benefits of anticholinergic medications in individual patients 5.