Why are anticholinergics problematic?
Anticholinergics have long been recognised as causing symptoms such as dry mouth, constipation and urinary retention. Exposure to anticholinergic agents has also been linked to impaired cognition and physical decline. There may also be an association with falls, and increased mortality and cardiovascular events. The table below shows that anticholinergic effects are dose dependent (adapted from reference1). Of note is, however, that there is significant inter-individual variability regarding anticholinergic dose and manifestations of signs and symptoms of toxicity, which is why it is essential to understand the patient’s perspective.
1Sumukadas D, McMurdo MET, Mangoni AA, Guthrie B. Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data. Age and Ageing 2014 July 1, 2014;43(4):515-21.