How can I protect against anticholinergic medications?

From the Guidelines

To protect against anticholinergic medications, it is crucial to maintain an updated list of all your medications and share it with your healthcare providers, as anticholinergic burden can adversely affect cognition and functionality, particularly in older patients 1. When considering protection against anticholinergic medications, several key points must be taken into account:

• Common anticholinergics include diphenhydramine (Benadryl), oxybutynin (Ditropan), amitriptyline (Elavil), paroxetine (Paxil), and some over-the-counter sleep aids and allergy medications.
• It is essential to ask your doctor about alternatives with lower anticholinergic properties if you're at risk, especially if you're older or have cognitive concerns, as these medications can cause significant adverse effects, including sedation, performance impairment, and anticholinergic effects 1.
• When anticholinergics are necessary, start with the lowest effective dose and regularly review with your doctor whether they're still needed, as this can help minimize the risk of adverse effects.
• Staying hydrated is also important, as these medications can cause dry mouth and constipation.
• Being alert for side effects like confusion, blurry vision, urinary retention, and increased heart rate is vital, as anticholinergics block acetylcholine, a neurotransmitter important for memory and cognitive function, which is why they can cause these side effects, particularly in older adults.
• If you experience concerning symptoms while taking these medications, contact your healthcare provider promptly rather than stopping them abruptly, as this can help prevent potential complications. Key considerations for specific populations, such as older adults, include:
• Older adults are more sensitive to the psychomotor impairment promoted by first-generation antihistamines and are at increased risk for complications such as fractures and subdural hematomas caused by falls 1.
• They are also more susceptible to adverse anticholinergic effects, making it essential to approach the use of first-generation antihistamines with caution in this population.

From the FDA Drug Label

Patients should be informed that anticholinergic agents such as oxybutynin may produce drowsiness (somnolence), or blurred vision, patients should be advised to exercise caution Patients should be informed that alcohol may enhance the drowsiness caused by anticholinergic agents such as oxybutynin. The concomitant use of oxybutynin with other anticholinergic drugs or with other agents which produce dry mouth, constipation, somnolence (drowsiness), and/or other anticholinergic-like effects may increase the frequency and/or severity of such effects Patients should be informed that antimuscarinic agents such as tolterodine tartrate tablets may produce the following effects: blurred vision, dizziness, or drowsiness. Patients should be advised to exercise caution in decisions to engage in potentially dangerous activities until the drug's effects have been determined

To protect against anticholinergic medications, it is essential to:

• Exercise caution when taking these medications, especially when combined with other anticholinergic drugs or agents that produce similar effects.
• Be aware of potential side effects, such as drowsiness, blurred vision, and dizziness, and take necessary precautions to avoid accidents or injuries.
• Avoid consuming alcohol while taking anticholinergic medications, as it may enhance drowsiness.
• Follow the recommended dosage and consult with a healthcare professional if you have any concerns or questions about your medication regimen 2 3.

From the Research

Protecting Against Anticholinergic Medications

To protect against anticholinergic medications, several strategies can be employed:

• Minimizing the use of anticholinergic medications whenever possible, as suggested by 4
• Regularly assessing and optimizing anticholinergic burden prior to prescribing these medications, as recommended by 5
• Using the lowest effective dose and limiting the duration of treatment with anticholinergic medications, as advised by 6
• Considering alternative treatments, such as melatonin and melatonin receptor agonists, for conditions like nocturia, although more research is needed to fully understand their efficacy and safety, as noted by 7

Reducing Anticholinergic Burden

Reducing anticholinergic burden can be achieved by:

• Avoiding medicines with anticholinergic activity when clinically possible, as suggested by 4
• Reducing the dose of anticholinergic medications when feasible, as recommended by 4
• Deprescribing medicines with anticholinergic activity when no longer necessary, as advised by 4

Monitoring for Adverse Effects

It is essential to monitor for adverse effects associated with anticholinergic medications, including:

• Cognitive decline and dementia, as reported by 5
• Peripheral adverse effects, such as urinary retention, as noted by 6
• Central effects, such as impaired cognition, as mentioned by 6