From the Guidelines
Common anticholinergic medications include diphenhydramine, hydroxyzine, and other old antihistamines, which can cause CNS impairment, delirium, slowed comprehension, impairs vision, urine retention, constipation, sedating, and falling, as noted in a recent study 1. These medications work by blocking acetylcholine receptors in the parasympathetic nervous system, producing various effects depending on their specific target. Some key points to consider when prescribing anticholinergic medications include:
- They can be used to treat conditions like overactive bladder, COPD, motion sickness, and Parkinson's disease
- Common side effects include dry mouth, blurred vision, constipation, urinary retention, and confusion, especially in elderly patients
- These medications should be used cautiously in patients with glaucoma, prostatic hypertrophy, or cognitive impairment
- Anticholinergics work by competitively blocking muscarinic receptors, preventing acetylcholine from binding and inhibiting parasympathetic nervous system activity, which explains both their therapeutic effects and side effect profile
- A study from 2021 1 highlights the risks of anticholinergic medications in older adults, including broad muscarinic receptor blockade, CNS impairment, and increased risk of falls
- Another study from 2008 1 notes that first-generation antihistamines, such as diphenhydramine and hydroxyzine, have significant potential to cause sedation, performance impairment, and anticholinergic effects, and should be used with caution in older adults.
From the FDA Drug Label
Glycopyrrolate injection is compatible for mixing and injection with the following injectable dosage forms: atropine sulfate, USP; ... scopolamine HBr, USP; The FDA drug label mentions glycopyrrolate and scopolamine as anticholinergic medications.
- Glycopyrrolate is the drug being described in the label.
- Scopolamine is mentioned as another anticholinergic medication that is compatible with glycopyrrolate for mixing and injection.
- Atropine is also mentioned as an anticholinergic medication that is compatible with glycopyrrolate for mixing and injection 2.
From the Research
Common Anticholinergic Medications
- Antihistamines 3
- Atropine 4, 3, 5, 6
- Tricyclic antidepressants 3, 7
- Antipsychotics 3, 7
- Topical mydriatics 3
- Antispasmodics 3
- Sleep aids 3
- Cold preparations 3
- Anisodamine 4
- Anisodine 4
- Scopolamine 4, 3, 5, 6
- Tiotropium 4
- Glycopyrrolate 6
- Scopolamine derivatives 6
- Hyoscyamine 5
Medications with Anticholinergic Properties
These medications can have primary or secondary anticholinergic effects, contributing to adverse outcomes ranging from mild-to-severe to potentially lethal 7. The Anticholinergic Drug Scale and tables listing drugs with known anticholinergic properties may help in guiding clinical decision-making to reduce anticholinergic burden 7.
Uses of Anticholinergic Medications
Anticholinergic medications are used to treat various conditions, including: