piperidines and diphemanil-methylsulfate

The results of a multicentre inquiry started in 1988 in reference centres of sudden infant death are presented. This study concerns the sudden and unexplained mortality of infants under 1 year of age who were treated with atropinics for an alleged risk of sudden death. The 7,851 infants involved were divided into 2,605 siblings, 1,067 premature babies and 4,179 infants who experienced malaises. Only one of the 2,034 infants treated with atropinics (385 siblings, 435 prematures, 1,214 with malaise) died, as opposed to 27 deaths among the 5,817 infants who where not treated (10 deaths among 2,220 siblings, 6 among 632 premature and 11 among 2,965 infants with malaise); P = 0.005. These results are encouraging, but they suffer from the limitations and biases inherent in all large inquiries. They certainly do not allow us to conclude without reservation that vagal hyperreflectivity is the mechanism responsible for sudden infant death and that atropinics must be systematically given to all infants at risk. Wide and randomized prospective studies are highly desirable in this particular field.

Topics: Drug Evaluation; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Parasympatholytics; Piperidines; Risk Factors; Sudden Infant Death; Surveys and Questionnaires

Fifteen patients with severe gustatory sweating after total parotidectomy and facial nerve preservation were asked to take part in a double-blind study. All patients were alternatively treated with topically applied placebo and topically applied 2% diphemanil methylsulfate (an anticholinergic agent). A 10-day period was allowed between applications for return of symptoms. Two-percent diphemanil methylsulfate provided partial relief in 33.3% of patients and total relief in 40% of patients. Involvement of the hairy temporal line region with gustatory sweating was the main reason for failure. Duration of relief varied from 2 to 4 days. The only side effect was dryness of the mouth noted in two patients.

Topics: Administration, Topical; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Parasympatholytics; Piperidines; Sweating, Gustatory

Parenterally administered diphemanil methylsulfate, a quarternary ammonium compound with both parasympatholytic and direct bronchial smooth muscle relaxing properties, has been found effective in the treatment of bronchial asthma. The present study was undertaken to test the effectiveness of inhaled diphemanil in preventing histamine induced bronchoconstriction in asymptomatic adult asthmatics. Twenty subjects, aged 19-40 years (average 25) were studied, each on three different days, observing an interval of at least 70 hours between testing. On day one, airway sensitivity to inhaled histamine was determined. On days two and three, histamine challenge was repeated 20 minutes after inhalation of either diphemanil (2 mg) or its vehicle in a double-blind crossover design. Airway sensitivity was assessed by determining cumulative log dose units of inhaled histamine required to provoke a 20% decline in FEV1 (log PD20 - FEV1). Diphemanil did not prevent histamine induced bronchoconstriction nor did it significantly affect log PD20 - FEV1 (p = 0.59). We conclude that a 2 mg dose of diphemanil, administered by oral inhalation 20 minutes before histamine challenge, is ineffective in protecting against induced bronchospasm in asymptomatic adult asthmatics.

Topics: Administration, Intranasal; Adult; Asthma; Bronchial Provocation Tests; Bronchial Spasm; Bronchodilator Agents; Female; Forced Expiratory Volume; Histamine; Humans; Male; Parasympatholytics; Piperidines

A simple detection system with a high-performance liquid chromatography (HPLC) with positive ionisation-tandem mass spectrometry (ESI-MS/MS) for determining diphemanil methylsulphate (DMS) levels in human plasma using 4-diphemanylmethylene,1-methylpiperidine as an internal standard (I.S.), is proposed. The acquisition was performed with the multiple reactional monitoring (MRM) mode, by monitoring the transitions: m/z 278>262 for DMS and m/z 263>247 for the I.S. The method involved a simple single-step deproteinisation with acetonitrile. The analyte was chromatographed on a Zorbax C18 reversed-phase chromatographic column by isocratic elution with 10(-3)M ammonium acetate and 10(-3)M hexafluorobutyric acid, adjusted to pH 7.0 with ammoniac/acetonitrile (40/60, v/v). The results were linear over the studied range (0.5-50.0 ng mL(-1)) and the total analysis time for each run was 10 min. The mean extraction apparent recoveries expressed at the 95% intervals of confidence were 94-104% for DMS and 92-106% for the I.S. The intra- and inter-assay precisions were 4.6-8.4% and 2.9-10.6%, respectively. The limit of quantification was 0.15 ng mL(-1). The devised assay was successfully applied to the residual concentrations monitoring in infant.

Topics: Chromatography, High Pressure Liquid; Humans; Infant; Piperidines; Reproducibility of Results; Spectrometry, Mass, Electrospray Ionization; Tandem Mass Spectrometry

Diphemanil methylsulfate (Prantal) is a quaternary ammonium with parasympathicolytic properties. It is used in premature and term neonates with bradycardias related to vagal hyper reflectivity (HRV).. To assess the use of Prantal in the French neonatal and intensive care units: its indications, its modalities of use, its side effects and the number of patients treated during 1 year (2004) in France.. A questionnaire was electronically sent to all neonatology units and all neonatal intensive care units in France.. Among 202 units, 121 (60%) answered the questionnaire. Prantal was reported to be used in 51 (42.1%) units. Among them, 38 (31.4%) actually treated 169 patients in 2004 with a mean number of patients treated by unit of 4. The diagnostic of HRV was supported by: a history of malaise (84.3%), bradycardia (94.1%), oculocardiac reflex (74.5%), cardiac Holter (76.4%), cardiorespirographic recording (19.6%), esophageal pHmetry (35.2%) and esophageal fibroscopy (21.5%). The mean starting dosing was 4.7 mg/kg/d, the mean maximal dosing was 9 mg/kg/d and the mean daily intakes were initially 2.3 and secondary 2.9. Prantal dosing was adjusted to weight in 54.9%, every month in 85.7%. Treatment was stopped at the mean post-natal age of 6 months, mostly in a progressive manner and without monitoring help.. Prantal was seldom used in 2004 in France for different reasons: HRV is an uncertain entity, the efficacy of Prantal has not been validated and atropinic side effects can be encountered.

Topics: Drug Utilization; France; Humans; Infant; Intensive Care Units; Parasympatholytics; Piperidines; Surveys and Questionnaires

Diphemanil methylsulfate (DMS) is a synthetic antimuscarinic agent classically used in infants for vagal hypertonia-related symptoms. A normal-phase, isocratic liquid chromatographic method was developed for the quantitative determination of DMS in bulk drugs and in pharmaceutical forms. The method has been completely validated and robustness of this method has been studied. The limit of detection (LOD) for DMS impurities namely, impurity 1 and 2 were found to be 11 and 46 ng/ml. The limit of quantitation (LOQ) was found to be 49 and 139 ng/ml for impurity 1 and 2, respectively. The stability studies have been performed for 2 and 10 mg DMS tablets subjected at various temperatures: 25 degrees C (long term storage condition) and 40 degrees C (accelerated storage condition) for 18 and 6 months, respectively. At 25 degrees C, the samples were found to be stable for the study period. At 40 degrees C, 2 and 10 mg DMS tablets showed degradation up to 5 and 10% over a 6-month period.

Topics: Algorithms; Chromatography, High Pressure Liquid; Drug Stability; Drug Storage; Muscarinic Antagonists; Piperidines; Reproducibility of Results; Tablets; Temperature; Time Factors

Angelman's syndrome is an association of severe mental retardation with absence of language, ataxia, convulsions and hyperactive, joyful behaviour with frequent bouts of laughing. Genetic diagnosis is possible in about 80% of cases. No cardiovascular abnormalities have been described in this syndrome to date. The authors report the cases of three children with Angelman's syndrome who presented with severe malaise due to increased vagal tone. The age of onset of symptoms was between 20 months and 8 years. One of the children had malaises triggered by bouts of laughing. The diagnosis was confirmed in all three cases by the results of Holter 24 hour ECG recording and oculo-cardiac reflex. The treatment chosen was Diphemanil (Prantal) in the two patients under 2 years of age (after failure of a trial of betablockers in one case) and Disopyramide for the oldest child with excellent results in all cases. However, one child died suddenly at the age of 6, two years after stopping diphemanil. Based on these observations, the authors suggest that all malaises in patients with Angelman's syndrome should be investigated by Holter ECG and oculo-cardiac reflex (or tilt test). In view of the potential gravity of the syncopal attacks, long-term medical treatment seems to be justified.

Topics: Age of Onset; Angelman Syndrome; Child; Dipyridamole; Electrocardiography, Ambulatory; Female; Humans; Infant; Male; Parasympatholytics; Piperidines; Reflex, Oculocardiac; Vagus Nerve; Vasodilator Agents

Parasympathetic hyperactivity is found in some infants presenting faint episodes and could be responsible of certain Sudden Infant Death Syndrome cases. Therefore it was interesting to look for a noninvasive biochemical indicator of parasympathetic activity. A parasympaticomimetic syndrome associated with muscarinic receptor stimulation, which has been followed during 48 h, was obtained in the awake rat by reserpine injection (6.25 mg/kg at T0 and T24h), and a model of prolonged parasympatholytic syndrome, by administration of diphemanil-methylsulfate (DPMS), a muscarinic receptor inhibitor, in drinking water (mean daily dosis: 150 mg/kg). Significant bradycardia and tachycardia were respectively observed. In the reserpine-treated rats we found significantly increased cyclic guanosylmonophosphate (cGMP) urinary excretion between T24h and T48h, when compared with vehicle-treated controls (+87% in one experiment, +135% in the other, when expressed in pmol/microg creatinine); norepinephrine urinary excretion between T24h and T48h was decreased (-44%); the increase in cGMP urinary excretion was not significantly modified by the NO-synthase inhibitor, L-nitroarginine-methyl-ester. In the DPMS-treated rats, we observed a significantly decreased cGMP (-20%) and increased norepinephrine urinary excretion (+61%). Thus cGMP excretion varied in opposite directions in the reserpine- and DPMS-treated rats. The link between these modifications in cGMP excretion and muscarinic receptor stimulation or blockade has still to be fully demonstrated. Urinary cGMP excretion could be tested as screening parameter in infants at risk of faint episodes associated with bradycardia.

Topics: Animals; Autonomic Nervous System Diseases; Cyclic GMP; Dose-Response Relationship, Drug; Heart Rate; Hemodynamics; Male; Muscarinic Agonists; Muscarinic Antagonists; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Norepinephrine; Parasympathetic Nervous System; Parasympatholytics; Piperidines; Rats; Rats, Sprague-Dawley; Reserpine; Syndrome

Serious undesirable cardiac side effects have been reported with treatment with diphemanil methylsulfate (Prantal) in premature babies or neonates. To understand the origin of this problem, the authors undertook an electrophysiological study of the effects of this product in vitro on rabbit Purkinje fibres. In three separate series (N = 5 to N = 8), the effects of increasing concentrations (0.1 microM-30 microM) of diphemanil methylsulfate, different frequencies of stimulation (0.2 Hz, 1 Hz, 2 Hz) and duration of exposition (60 min followed by 120 min washout) were observed on the properties of the action potential. The results show a clearcut antiarrhythmic Class III type action characterised by a concentration-dependent prolongation of the action potential duration with an inverse frequency dependency without significant changes of the other parameters. During stimulation at 0.2 Hz, early post-depolarizations and induced activity were observed in 3/8 of the fibres exposed to 10 microM and 8/8 fibres exposed to 30 microM. The effect did not attain a steady state after 60 min of exposition. It was not reversed by 120 min of washout of the preparation. These results were compatible with the reported cardiac arrhythmic effects of prolongation of the QT interval and torsades de pointe.

Topics: Action Potentials; Animals; Arrhythmias, Cardiac; Child; Drug Evaluation, Preclinical; Electric Stimulation; Electrocardiography; Humans; Long QT Syndrome; Piperidines; Purkinje Fibers; Rabbits

Topics: Humans; Infant, Newborn; Parasympatholytics; Piperidines

Bradycardia in preterm infants may require anticholinergic therapy (diphemanil methylsulphate). Such treatment may cause prolongation of QT interval and auriculoventricular block.. Three premature infants born before 34 weeks of gestational age were given 6-8 mg/kg/d diphemanil because they suffered from bradycardiac episodes. Aggravation and/or persistence of bradycardia required withdrawal of gavage feeding: heart block occurred within a few hours which subsided after cessation of diphemanil and oral refeeding. Diphemanil at progressive dosage was later introduced safely in two of these infants.. The short interval of time between the oral feeding withdrawal and occurrence of heart block justified therapy be stopped or transiently reduced whenever oral feeding must be interrupted.

Topics: Administration, Oral; Female; Heart Block; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Male; Parasympatholytics; Piperidines

Topics: Area Under Curve; Female; Half-Life; Humans; Infant, Newborn; Infant, Premature; Male; Muscarinic Antagonists; Piperidines

Diphemanil methylsulfate is an atropin-like drug used in some infants suffering from vagal bradycardia. Its pharmacokinetic parameters are known for adults but not for infants. The report describes these parameters in six infants.. Five infants aged 35 to 109 days (mean: 62 +/- 28) and weighing 3.5 to 5.3 kg (mean: 4.3) were included in the study with the formal consent of their parents. All suffered from vagal hyperreactivity. The sixth younger full-term infant was aged 10 days and weighed 4 kg. They were given a single dose (3 mg/kg) of diphemanil methylsulfate orally, after a minimal fast of 4 hours. Blood samples were collected at T0 and 3, 6, 8, 12 and 24 hours after administration. Urines were also collected from 1 hour before drug administration to 24 hours after. Plasma concentrations of diphemanil methylsulfate were measured by gas-exchange chromatography.. The peak plasma concentration in the five infants occurred at 3.9 +/- 2.3 hours (range: 2.9-8 hours). Half-life was 8.6 +/- 2.4 hours and tended to decrease with age. All the other parameters were identical to those found in adults. The peak plasma concentration occurred in the sixth younger infant at 2.9 hours, with a half-life of 17.2 hours. Renal clearance was high (0.3 l/h/kg).. The relatively long half-life of diphemanil methylsulfate allows this drug to be given every 8 hours. This longer interval is more comfortable for the patients and their parents. The high renal clearance suggests that this drug is excreted by both glomerular filtration and tubular secretion.

Topics: Age Factors; Female; Half-Life; Humans; Infant; Male; Parasympatholytics; Piperidines; Vagus Nerve

Diphemanil can be useful in some neonates presenting with bradycardia due to vagal hyperreflectivity. Paradoxically, this drug may induce atrio-ventricular (AV) block in premature babies.. Case no 1. A premature neonate suffering from acute respiratory distress from birth required respiratory support, antibiotics and caffeine. Despite this treatment, he underwent many episodes of apnea, and bradycardia that appeared on day 4 and did not respond to IV doxapram (1 mg/kg/h). He was given diphemanil on day 9 (10 mg/kg/d) and permanent bradycardia with complete AV block and a normal QT interval appeared 2 days later. Cessation of diphemanil and administration of IV isoprenaline led to a normal sinusal rhythm, but there were bladder, intestinal and ocular signs of atropinic intoxication. A complete definitive recovery occurred 5 days after cessation of diphemanil. Case no 2. A premature neonate developed episodes of apnea 2 days after birth. These episodes persisted and were complicated by bradycardia on day 4 despite administration of caffeine. Vagal stimulation on day 7 was positive and the infant was then given diphemanil (10 mg/kg/d). Permanent bradycardia occurred 2 days later, with partial AV block and a normal QT interval. The child recovered a normal sinusal rhythm 2 days after cessation of diphemanil.. Anticholinergic therapy may cause permanent bradycardia due to AV block in premature infants. This therapy should not be given to premature infants without a prior ECG. Doses lower than those used in infants are recommended.

Topics: Bradycardia; Bronchodilator Agents; Drug Administration Schedule; Heart Block; Humans; Infant, Newborn; Infant, Premature; Male; Parasympatholytics; Piperidines; Respiratory Distress Syndrome, Newborn

The pharmacokinetics of diphemanil methylsulphate was evaluated after oral administration of a single 3 mg.kg-1 dose to 5 infants being treated for symptomatic bradycardia. The mean pharmacokinetic parameters of oral diphemanil methylsulphate in infants were similar to those in adults. The mean half-life was 8.6 h. This would allow administration three times a day in infants instead of four to six times a day, as currently prescribed. The mean residence time decreases significantly with age (Spearman's r' = -1), and there is a trend for the half-life to decrease with age (r' = -0.9; NS), suggesting an influence of maturation on its elimination.

Topics: Administration, Oral; Bradycardia; Drug Administration Schedule; Half-Life; Humans; Infant; Parasympatholytics; Piperidines

The pharmacokinetic parameters of oral diphemanil methylsulphate have been evaluated in six healthy male volunteers. Absorption of the drug was slow (tmax = 2 to 4 h), the mean half-life was 8.35 h, and the amount of the drug recovered in urine within 48 h ranged from 0.6 to 7.4% of the administered dose. The results suggest low bioavailability, assuming that the drug is poorly metabolized.

Topics: Administration, Oral; Adult; Humans; Male; Metabolic Clearance Rate; Piperidines

Topics: Adult; Astringents; Diagnosis, Differential; Humans; Male; Mydriasis; Piperidines

Four premature infants presenting with episodes of bradycardia in the first weeks of life were given diphemanil. One of them received an overdose accidentally. Paradoxically, this induced a permanent bradycardia leading to the discovery of a grade II A-V block as well as a prolonged QT interval. Discontinuation of the drug resulted in a prompt normalization of these changes. It is felt that this anticholinergic therapy may have caused a prolongation of the QT interval and, therefore, a partial A-V block in case of sinus tachycardia. Thus, such a therapy should not be given to young premature infants without having checked the QT interval on a ECG tracing and having made sure that it is adapted to the actual heart rate. It is also advised to reduce usual doses.

Topics: Bradycardia; Electrocardiography; Female; Heart Block; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Parasympatholytics; Piperidines

We report a case of vagal hypertonia syndrome in a newborn infant, developed after surgical repair of an aortic coarctation combined with banding of the pulmonary artery trunk. The parasympathetic activity had adverse repercussions on haemodynamics. The diagnosis was confirmed by prolonged asystole on the oculocardiac reflex and by concomitant arrhythmia and disorders of conduction demonstrated by Holter recordings. To our knowledge, no other case of vagal hypertonia associated with a congenital cardiopathy has yet been reported. Infants with this syndrome are at a high risk of sudden death. Treatment with vagolytic drugs is of questionable value, and prolonged supervision of the patient is mandatory.

Topics: Bradycardia; Cranial Nerve Diseases; Follow-Up Studies; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant, Newborn; Male; Parasympatholytics; Piperidines; Sudden Infant Death; Syndrome; Vagus Nerve

For a period of 20 months, 50 consecutive infants (mean age: 11 months) were given Diphemanil (atropine like synthetic drug) for reflex symptomatic bradycardia of probable vagal origin. Treatment's results were evaluated with the study of oculo-cardiac reflex (OCR) and Holter monitoring performed before and 3 months after the beginning of Diphemanil. If tolerance was generally good, it was not possible to demonstrate the clinical efficacy of the treatment on the whole group. However, assertive success was seen on individual cases. Holter and OCR data improved statistically. The other therapeutical means aiming at warning possible complications of the hypertonic vagal reflex were reviewed: inserting a cardiac pace-maker does not always prevent sudden death; a nodal sinus surgical selective denervation might be justified in certain exceptional cases, because of the severity of the spontaneous evolution or of the resistance to medical treatment.

Topics: Bradycardia; Child, Preschool; Cranial Nerve Diseases; Female; Humans; Infant; Infant, Newborn; Male; Parasympatholytics; Piperidines; Sudden Infant Death; Vagus Nerve

Topics: Child, Preschool; Humans; Parasympatholytics; Piperidines; Tachycardia

Topics: Arrhythmias, Cardiac; Child, Preschool; Follow-Up Studies; Humans; Infant; Infant, Newborn; Metaproterenol; Methods; Piperidines; Postoperative Complications; Prognosis; Transposition of Great Vessels

Fourteen infants presenting with unexplained episodes of weakness or fainting were investigated by repeated Holter monitor recordings and oculocardiac reflexes (OCR). The recordings were then compared with those of 10 normal children in order to try to establish the criteria of vagal hyperreflexia. Results of OCR were collated with those of Holter: there was a good correlation between the length of the cardiac arrest on the OCR and the minimal instantaneous frequency and the maximal change of instantaneous frequency recorded on the Holter. The diagnostic difficulties of these vaso-vagal episodes in infants are emphasized. The potential gravity of these episodes and the possible relation with the sudden infant death syndrome are then discussed in the light of these cases.

Topics: Autonomic Nervous System Diseases; Child, Preschool; Electrocardiography; Female; Humans; Infant; Male; Parasympatholytics; Piperidines; Reflex, Oculocardiac; Syncope; Vagus Nerve

Ipratropium and diphemanil are synthetic quaternary ammonium compounds with antimuscarinic properties. By using in vitro measurements of tension changes in isolated guinea-pig trachealis muscle strips and in vivo measurements of lung mechanics changes in anesthetized, vagotomized cats, the two drugs were compared in terms of their relative bronchodilator potency, mode of action and apparent site of activity in the bronchial tree. Ipratropium and diphemanil were about equipotent in antagonizing airway smooth muscle contraction induced by the cholinergic agonists, methacholine (in vitro) and carbachol (in vivo). When noncholinergic stimulation was used to augment smooth muscle tone, i.e., hypertonic potassium in the isolated preparations and serotonin in the vagotomized animals, only diphemanil exhibited significant bronchodilator activity. Simultaneous measurements of pulmonary resistance and dynamic compliance were used to partition in vivo bronchodilator effects between large and small airways. The parasympatholytic bronchodilator effects of both drugs were distributed uniformly along the bronchial tree, whereas the direct spasmolytic action of diphemanil appeared to manifest itself preferentially on large airways.

Topics: Animals; Atropine; Atropine Derivatives; Bronchodilator Agents; Female; Guinea Pigs; In Vitro Techniques; Ipratropium; Isoproterenol; Methacholine Compounds; Muscle Contraction; Muscle, Smooth; Parasympatholytics; Piperidines; Potassium Chloride; Trachea

Topics: Humans; Hyperhidrosis; Parasympatholytics; Piperidines; Podiatry; Powders; Sweat Gland Diseases; Sweating

Topics: Humans; Hyperhidrosis; Parasympatholytics; Piperidines; Sweating

Topics: Antiperspirants; Humans; Parasympatholytics; Piperidines; Sweating

Topics: Gastrointestinal Diseases; Parasympatholytics; Perphenazine; Phenobarbital; Piperidines

Topics: Atropine; Autonomic Agents; Gastric Juice; Humans; Phenothiazines; Piperidines

Topics: Galvanic Skin Response; Methantheline; Parasympatholytics; Piperidines; Propantheline; Quaternary Ammonium Compounds; Reflex; Sympatholytics

Topics: Humans; Hyperhidrosis; Parasympatholytics; Piperidines; Sweating

Topics: Humans; Hyperhidrosis; Parasympatholytics; Piperidines; Sweating

Topics: Cholinergic Antagonists; Humans; Parasympatholytics; Peptic Ulcer; Piperidines; Scopolamine Derivatives

Topics: Parasympatholytics; Piperidines

Topics: Cholinergic Antagonists; Parasympatholytics; Piperidines; Skin Diseases

Topics: Dairy Products; Humans; Muscarinic Antagonists; Parasympatholytics; Piperidines; Skin Diseases

Topics: Benzhydryl Compounds; Gastric Juice; Humans; Parasympatholytics; Piperidines; Stomach; Sulfuric Acid Esters

Topics: Duodenal Ulcer; Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Hyperhidrosis; Parasympatholytics; Piperidines; Sweating

Topics: Cholinergic Antagonists; Gastroenterology; Gastrointestinal Tract; Humans; Parasympatholytics; Piperidines

Topics: Digestion; Gastric Emptying; Methantheline; Parasympatholytics; Piperidines; Quaternary Ammonium Compounds; Stomach

Topics: Diet; Parasympatholytics; Peptic Ulcer; Piperidines; Sulfuric Acid Esters

Topics: Animals; Dogs; Parasympatholytics; Piperidines; Regression Analysis

Topics: Disease Management; Duodenal Ulcer; Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Body Temperature; Humans; Methantheline; Parasympatholytics; Piperidines; Quaternary Ammonium Compounds; Sweating

Topics: Gastrointestinal Diseases; Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Asthma; Humans; Parasympatholytics; Piperidines; Spirometry

Topics: Female; Humans; Parasympatholytics; Piperidines; Pregnancy; Pregnancy Complications; Vomiting

Topics: Follow-Up Studies; Parasympatholytics; Peptic Ulcer; Piperidines; Ulcer

Topics: Methantheline; Parasympatholytics; Peptic Ulcer; Piperidines; Quaternary Ammonium Compounds

Topics: Cholinergic Antagonists; Disease; Duodenum; Gastritis; Humans; Parasympatholytics; Peptic Ulcer; Piperidines; Stomach Diseases

Topics: Digestion; Gastric Juice; Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Cholinergic Antagonists; Endocarditis; Endocarditis, Subacute Bacterial; Humans; Peptic Ulcer; Piperidines

Topics: Airway Obstruction; Animals; Asthma; Behavior, Animal; Humans; Parasympatholytics; Piperidines; Social Behavior

Topics: Humans; Hyperhidrosis; Methantheline; Parasympatholytics; Piperidines; Quaternary Ammonium Compounds; Sweat Gland Diseases; Sweat Glands

Topics: Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Ammonium Compounds; Cell Movement; Parasympatholytics; Peptic Ulcer; Piperidines

Topics: Dermatology; Humans; Parasympatholytics; Piperidines; Skin Diseases

Topics: Methantheline; Peptic Ulcer; Piperidines; Quaternary Ammonium Compounds

Topics: Humans; Hyperhidrosis; Parasympatholytics; Piperidines; Sweating

Topics: Benzhydryl Compounds; Parasympatholytics; Piperidines; Sulfuric Acid Esters