Anticholinergic Side Effects in the Elderly

Anticholinergics make up quite a big portion of the Beer’s Criteria. As patients age, changes in their body increase the chances of side effects, drug-drug interactions, and a prescribing cascade. Below is a list of common side effects to anticholinergic medications.

  1. Confusion
    • Check for anticholinergic medications and side effects prior to starting patients on dementia medications like donepezil or memantine.
  1. Drowsiness/sedation
    • Patients may already suffer from lethargy and have great difficulty completing simple activities of daily living with additional anticholinergic sedation.
  1. Blurred vision/Dry eyes
    • Difficulty seeing may lead to increase falls among other things. Watch for patients on artificial tears to see if any anticholinergics may be contributing.
  1. Difficulty urinating
    • Watch for additional medications like tamsulosin, see if anticholinergics could be cut back instead.
  1. Dry mouth
    • Monitor for increased thirst and addition of saliva substitutes.
  1. Constipation
    • This is a major contributor to prescribing cascades, patients keep going up and up on laxatives. Check for opportunities to cut back on anticholinergics.

 A few examples of anticholinergic medications:

Antihistamines, antipsychotics, muscle relaxants, cyproheptadine, tri-cyclic anti-depressants, oxybutynin, olanzapine, promethazine, ipratropium, atropine, rivastigmine, Spiriva.

Comments or questions are welcome.

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