Potentially Inappropriate Anticholinergics
The elderly are more susceptible to adverse effects of anticholinergic drugs, and symptoms are often
overlooked or attributed to normal aging. It is imperative that prescribers routinely talk with their
patients to avoid the following:
Insidious cognitive impairment, confusion, acute delirium
Increased risk of falls
Diminished efficacy of dementia therapies
Common side effects: constipation, urinary retention, dry mouth, blurred vision, etc
Remember that symptoms may develop in those who have previously tolerated therapy.
Steps to reduce potentially inappropriate anticholinergic drugs in the elderly:
Prescribe safe/effective alternatives to anticholinergic drugs when available.
When anticholinergic agents are required, select best tolerated agents and use at lowest
effective doses for shortest possible duration.
Routinely evaluate your patients for anticholinergic toxicity.
Discontinue drugs if significant adverse effects are seen or if clinical efficacy is suboptimal.
Use caution when initiating/discontinuing drugs. Appropriate tapering is recommended.
Anticholinergic agents identified in either Beers List or NCQA HEDIS Measures
Amitriptyline- Elavil, Endep
Amoxapine- Asendin, Asendis, Defanyl, Demolox, Moxadil
Atropine- Sal-Tropine, AtroPen, Atreza
Brompheniramine- Bromfed, Dimetapp, Bromfenex, and Dimetane
Chlorzoxazone- Parafon Forte, Paraflex, Relaxazone, Remular-S
Clemastine- Tavist, Tavegil
Cyclizine- Antivert, Bonine, Dramamine II, Marezine
Dexchlorpheniramine- Polaramine, Polaramine Repetabs
Dicyclomine- Bentyl, Byclomine, Dibent, Di-Spaz, Dilomine
Dimenhydrinate- Dramamine, Gravol, Vertirosan
Doxepin- Adapin, Sinequan, Zonalon
Homatropine- Hycodan, ophthalmic solution
Hydroxyzine- Vistaril, Atarax
Hyoscyamine- Anaspaz, Cystospaz, Donnamar, Levsin
I-Hyoscyamine- Atropine, Belladonna
Methscopolamine- Pamine, Pamine Forte
Nortriptyline- Pamelor, Aventyl HCl
Orphenadrine- Norflex, Banflex, Orphenate, Flexoject, Flexon, Mio-Rel, Myolin, Orfro,
Norflex Injectable, Antiflex
Oxybutynin- Ditropan, Ditropan XL, Urotrol, Oxytrol
Prochloroperazine- Compazine, Compazine Spansule, Compro, Procot
Scopolamine- Scopace, Transderm-Scop, Maldemar
Tolterodine- Detrol, Detrol LA
Trimethobenzamide- Tigan, Ticon, Benzacot
Tripelennamine- PBZ, PBZ-SR
Triprolidine- Zymine, Zymine XR, Tripohist