6 Notorious Side Effects of Anticholinergics and How They Contribute to the Prescribing Cascade

Why are anticholinergics on the naughty list of medications in the elderly (Beer’s criteria)? Side effects.  Side effects of anticholinergics can be very troubling.  Here’s a list of 6 big ones to remember including an example of the prescribing cascade for each!

  1. Sedating – Anticholinergics will likely be sedating which can be very problematic in elderly patients who may already lack energy.  Not only that, it can make everyday tasks much riskier (i.e. driving).  I’ve seen stimulants used in patients receiving anticholinergics!
  2. Dry Mouth – When you see an order for Biotine or other types of saliva substitutes, make sure your patient is not receiving a medication with anticholinergic side effects.
  3. Constipation – So many times I’ve seen patients have to go up, up, and up on laxative medications when anticholinergics have not been minimized.
  4. Confusion – Anticholinergic medication started or increased – weeks to months later, the patient is diagnosed with dementia and new medications like donepezil or memantine are started.
  5. Dry Eyes – When you see patients using artificial tears or other eye products, take a quick look at their medication regimen and make sure that anticholinergics are not causing the problem!
  6. Urinary retention – Here’s a classic case of the prescribing cascade involving anticholinergics causing urinary retention.

Enjoy the blog?  Make sure to check out my 30 medication mistakes, a free 6 page PDF full of clinical pharmacy pearls from my personal experience!


  1. Jones

    Eric, thank you for your great work. Kindly resend your 30 medication mistakes to me. I must confess that I did not save it anywhere for referencing.

    • Eric Christianson

      sent it!

  2. Felipe

    Yeah Eric, thank you for the constant emails. I appreciate your passion and dedication towards the profession. I am in my 3rd year of pharmacy school at Georgia. Not sure what my career plans are but 4th year rotations will expose me to a lot. I like ID a lot! Any advice going into my 4th year and how to treat my anxiety in regards to not knowing exactly what I want to do post graduation? My email is [email protected]. Thanks!

    • Eric Christianson

      Find your passion within the field Keep exploring and trying new things. Think about those topics/subjects that you didn’t mind studying or learning more about and try to pursue that versus the times when you are looking at the clock wishing time would pass quickly. Hope that helps!

  3. Nabeela Donaghey

    I am so pleased to have discovered your website. It is an interesting and might I also add a fun way to refresh all that knowledge from University years ago. I worked as a clinical pharmacist in Scotland and then in community pharmacy before moving unexpectedly to Germany a few years ago. The system here doesn’t have many clinical pharmacist posts and for me it is very frustrating as all my knowledge is untapped and slowly being forgotten. I was so chuffed at discovering your post because it consists of short concise bursts of information and my brain doesn’t go into overload when I am trying to translate everything into German. It is perfect for me to kick-start my memory and also to discover new facts. I take off my hat to you Sir! Thank you.

    • Eric Christianson

      Thank you!

  4. Gamal omar

    Great work I



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Written By Eric Christianson

February 3, 2016

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