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.

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Written By Eric Christianson

February 3, 2016

Free PDF – Top 30 Medication Mistakes

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