Managing drugs with anticholinergic activity

Abstract

Over the past two decades, considerable data have emerged on an association between drugs with anticholinergic activity and serious adverse effects in older people. Well-recognised anticholinergic adverse effects include dry mouth, blurred vision, constipation and urinary retention. Of particular concern is the potential impact on cognitive function with several studies showing that long-term use of medicines with anticholinergic activity is associated with worsening of cognitive function, increased incidence of dementia and increased mortality. This article gives an overview of the evidence, discusses some of the tools used to identify high-risk drugs and highlights issues to consider when prescribing drugs with anticholinergic activity with a view to reducing potential risks in older people and those at highest risk of cognitive impairment.

Delirium in psychiatric settings: risk factors and assessment tools in patients with psychiatric illness: a scoping review

“…Although the benefits of using antipsychotics may outweigh the risks for managing specific psychiatric symptoms, many studies that have found a causal relationship between antipsychotics and delirium or no therapeutic effect. Clozapine is contraindicated for delirium treatment due to its significant anticholinergic effects, which can exacerbate cognitive impairment and cause delirium [ 69 ]. Similarly, sustained-release olanzapine is potentially harmful for managing delirium because of its long-acting nature and risk of causing delirium [ 70 ].…”