Potentially Inappropriate Anticholinergics

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					                      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

Azatadine- Optimine


Benztropine- Cogentin

Brompheniramine- Bromfed, Dimetapp, Bromfenex, and Dimetane

Carisoprodol- Soma

Chlorzoxazone- Parafon Forte, Paraflex, Relaxazone, Remular-S

Clemastine- Tavist, Tavegil
Clidinium- Librax

Clomipramine- Anafranil

Cyclizine- Antivert, Bonine, Dramamine II, Marezine

Cyclobenzaprine- Flexeril

Cyproheptadine- Periactin

Dexchlorpheniramine- Polaramine, Polaramine Repetabs

Dicyclomine- Bentyl, Byclomine, Dibent, Di-Spaz, Dilomine

Dimenhydrinate- Dramamine, Gravol, Vertirosan

Diphenhydramine- Benadryl

Disopyramide- Norpace

Doxepin- Adapin, Sinequan, Zonalon

Flavoxate- Urispas

Glycopyrrolate- Robinul

Homatropine- Hycodan, ophthalmic solution

Hydroxyzine- Vistaril, Atarax

Hyoscyamine- Anaspaz, Cystospaz, Donnamar, Levsin

Imipramine- Tofranil

I-Hyoscyamine- Atropine, Belladonna

Meclizine- Antivert

Metaxalone- Skelaxin

Methocarbamol- Robaxin

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

Perphenzaine- Trilafon
Prochloroperazine- Compazine, Compazine Spansule, Compro, Procot

Propantheline- Pro-Banthine

Protriptyline- Vivactil

Scopolamine- Scopace, Transderm-Scop, Maldemar

Tolterodine- Detrol, Detrol LA

Trihexyphenidyl- Artane

Trimethobenzamide- Tigan, Ticon, Benzacot

Trimipramine- Surmontil

Tripelennamine- PBZ, PBZ-SR

Triprolidine- Zymine, Zymine XR, Tripohist

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