From the Guidelines
Strong anticholinergic medications, such as diphenhydramine, cyclobenzaprine, and oxybutynin, should be used with caution in older patients due to their potential to cause significant adverse effects on vision, urination, constipation, and cognition. These medications have broad muscarinic receptor blockade, which can lead to negative effects, particularly in aged patients where there is already a decline in acetylcholine physiology associated with aging 1. Examples of strong anticholinergic medications include:
- Older antihistamines like diphenhydramine
- Muscle relaxants such as cyclobenzaprine
- Overactive bladder agents such as oxybutynin These medications can cause a range of side effects, including dry mouth, blurred vision, constipation, urinary retention, and confusion, and their use has been associated with an increased risk of dementia in elderly patients 1. The "anticholinergic burden" of taking multiple anticholinergic drugs can also adversely affect cognition and functionality, and a Drug Burden Index has shown that drugs with strong anticholinergic properties are associated with a decline in cognition, functional status, and activities of daily living (ADL) scores in older patients 1.
From the FDA Drug Label
Anticholinergic and LABA medicines such as STIOLTO RESPIMAT help the muscles around the airways in your lungs stay relaxed to prevent symptoms, such as wheezing, cough, chest tightness, and shortness of breath. STIOLTO RESPIMAT combines an anticholinergic, tiotropium bromide and a long-acting beta2-adrenergic agonist (LABA) medicine, olodaterol Tiotropium is a long-acting, muscarinic antagonist which is often referred to as an anticholinergic. Especially tell your healthcare provider if you take: anticholinergics (including ipratropium, aclidinium, umeclidinium or another tiotropium-containing product such as SPIRIVA RESPIMAT or SPIRIVA HANDIHALER) atropine
Examples of strong anticholinergic medications include:
- Tiotropium
- Ipratropium
- Aclidinium
- Umeclidinium
- Atropine
From the Research
Strong Anticholinergic Medications
- The following are examples of strong anticholinergic medications:
- Tiotropium bromide, which has kinetic selectivity for M3 receptors and a duration of action of >24 hours 2, 3
- Ipratropium bromide, an anticholinergic drug frequently administered for the treatment of COPD 2, 3
- Tolterodine, which is used to treat overactive bladder symptoms 4, 5
- Solifenacin, which has been shown to have better efficacy and less risk of dry mouth compared to immediate release tolterodine 4
- Fesoterodine, which has been shown to have superior efficacy but higher risk of withdrawal due to adverse events and higher risk of dry mouth compared to extended release tolterodine 4
- Oxybutynin, which is used to treat overactive bladder syndrome 4, 5
- Darifenacin, emepronium bromide, propiverine, propantheline, and trospium chloride, which have been tested in clinical trials for the treatment of overactive bladder syndrome 5
Uses of Strong Anticholinergic Medications
- Strong anticholinergic medications are used to treat various conditions, including: