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Anticholinergic medications

Anticholinergics decrease acetylcholine activity to balance out the production of dopamine and acetylcholine. They are used to treat incontinence, depression and sleep disorders. Medications with strong anticholinergic effects, such as antihistamines that cause drowsiness, are well known for causing acute cognitive impairment in individuals with dementia and may cause confusion and hallucinations. Furthermore, with the cholinergic deficit in some forms of dementia, they could potentiate this deficit and antagonize any cholinesterase inhibiting medications. Adverse effects may include blurred vision, dry mouth and urinary retention. Single or combination gastrointestinal/urinary antispasmodics products should be avoided.

Several factors that may influence whether a patient develop cognitive impairment when exposed to
anticholinergic drugs:

  1. the number of AC drugs and the doses of the drugs used,
  2. baseline cognitive function (determines susceptibility) and
  3. the patient's response to medications (sensitivity and metabolic processing as determined by their liver and kidney function status).

Carefully evaluate the risk/benefit for these medications and consider alternatives. For example with incontinence, consider the following:

  • Functional vs urge incontinence
  • Scheduled toileting
  • Check post void residuals (especially in males as these medications can cause retention)
  • Reducing dose of cholinergic medication

If used, carefully evaluate effectiveness of medication and consider discontinuing if there is no improvement in six weeks.

Examples

  • Atropine
  • Belladonna alkaloids
  • Benzotropine mesylate (Cogentin®)
  • Dicyclomine (Bentyl®)
  • Flavoxate (Urispas®)
  • Hyosyamine (Levsinex®)
  • Oxybutynin (Ditropan®)
  • Scopolamin
  • Tolterodine (Detrol®)
  • Trihexyphenidyl HCL (Artane®)
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