Pipenzolate bromide (JB-323), an anticholinergic agent, which binds to muscarinic acetylcholine receptors as an antagonist. Pipenzolate bromide was studied as an antispasmodic agent, and to treat peptic ulcer.

Cimetropium bromide (cimetropium) is a semi-synthetic belladonna alkaliod, a quaternary derivatives of scopolamine. Cimetropium was used in Italy under the name Alginor for the treatment of painful gastrointestinal conditions, such as irritant bowel syndrome or infant colics as well as in preparation for diagnostic procedures. The drug exerts its action by binding to muscarinic receptors and inhibiting their activity.

Difemerine is antimuscarinic agent. It is used in the symptomatic treatment of visceral spasms. It may have anticholinergic side effects like dry mouth, dizziness, blurred vision and drowsiness. Anticholinergics must be used with caution in glaucoma and prostate hypertrophy patients.

Otilonium is a musculotropic spasmolytic agent belonging to the family of quaternary ammonium derivatives and successfully used in the treatment of patients affected by Irritable bowel syndrome (IBS) due to its specific pharmacokinetic and pharmacodynamic properties. The positive polarity of the head of the Otilonium molecule determines the main pharmacokinetic property of this drug: a minimal systemic absorption and the consequently high safety profile. Studies on animal models revealed a specific Otilonium accumulation in colonic circular muscle at therapeutic µm concentrations, while its plasma levels were 1000 times lower, together with a poor penetration of the drug in the central nervous system. Consistently, after oral administration to healthy volunteers, the Otilonium plasmatic concentration was very low, less than 1% of the drug was eliminated by urine, and 97% was eliminated by feces. Recent clinical studies showed comparable safety and tolerability for Otilonium and placebo. Otilonium was shown to inhibit the main patterns of human sigmoid motility in vitro, including: the tone of smooth muscle cells (SMCs); the rhythmic phasic contractions induced by the interstitial cells of Cajal; and the strong contractions induced by stimulation of enteric motor neurons mainly by blocking the calcium influx through L-type calcium channels on SMCs. Recent in vitro studies using cultured human colonic SMCs to further assess the musculotropic spasmolytic properties of Otilonium confirmed that this drug causes smooth muscle relaxation through the inhibition of voltage-gated calcium channels (L-type > T-type) and the inhibition of muscarinic and tachykinergic effects.

Prifinium bromide is antimuscarinic drug, which has antispasmodic, antiemetic effect. Prifinium bromideis approved for pain relief in Russia, Indonesia, Iraq, Tunisia and other countries.

Timepidium bromide is a quaternary ammonium antimuscarinic used for the symptomatic treatment of visceral spasms. It is a muscarinic antagonist.

Tiemonium (often used in a form of iodide or methylsulphate salt) is a muscarinic acetylcholine receptor antagonist, which is available in Asia (mainly Bangladesh) for the alleviation of muscle spasms of the intestine, biliary system, uterus and urinary bladder in gastrointestinal, biliary, urinary and gynecological diseases.