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List of Anticholinergic Drugs and Why Some of Them are Dangerous for Seniors

If you or someone you love is over the age of 60 and takes over-the-counter allergy, mood, or sleep medications, then you should consult your doctor immediately. There’s a good chance that one of these drugs is anticholinergic.

Drugs with anticholinergic properties block the action of the neurotransmitter chemical, acetylcholine. Acetylcholine helps send signals to other cells affecting muscle contraction, learning, and memory. Generally, these medications reduce spasms from smooth muscle and are used to treat overactive bladders and COPD; however, they are associated with increased risks of cognitive impairment.

Why Are Anticholinergic Drugs Used?

Drugs with anticholinergic properties have been used in medicine for decades to treat conditions such as:

  • Diarrhea and other gastrointestinal disorders
  • Asthma
  • Dizziness and motion sickness
  • Parkinson’s disease symptoms such as involuntary movements
  • Overactive bladder and urinary incontinence
  • Chronic obstructive pulmonary disease (COPD)

This group of medications can also be used in tandem with anesthesia. Anticholinergics can:

  • Maintain heartbeat regularity
  • Lower saliva secretion
  • Relax muscles

Anticholinergic Drugs and Seniors

Those over the age of 65 already have diminishing numbers of neurons or receptors in the brain; blocking the acetylcholine can accelerate this process. On top of this, medications stay in an older person’s system longer, as the kidneys and liver clear drugs slower in an aging body. The result is a build-up of anticholinergic properties blocking acetylcholine and negatively impacting your overall health.

Even when used as instructed, anticholinergics have some unpleasant side effects. Naturally, these will vary depending on the specific drug and dosage.

The side effects may include:

  • Blurry vision
  • Constipation
  • Drowsiness
  • Sedation
  • Trouble urinating
  • Memory issues
  • Delirium

Anticholinergics also decrease how much you sweat, causing your body temperature to rise. For older adults, in particular, this can lead to heatstroke. In the long term, these drugs increase the risk of dementia.

Pria Medication Dispenser
Pria Medication Dispenser

Although technologies like pill dispensers and medical alert systems are a partial solution for safety and independence, it’s still important to be wary of anticholinergic usage.

Consulting Your Pharmacist

Did you know most pharmacists will review your medications for free?

Older adults should frequently ask their pharmacist or doctor to audit their drugs. This can be particularly important for those taking multiple medications simultaneously. Medical professionals will screen for drug combinations that create high anticholinergic levels. Periodic and thorough reviews minimize the risk of adverse drug effects.

FYI: Be sure to inform your doctor or pharmacist of alcohol usage. Taking anticholinergic drugs with alcohol can result in unconsciousness or even death.

A Comprehensive List of Anticholinergic Drugs

Here’s a comprehensive list of Anticholinergic Drugs. This list is courtesy of The People’s Pharmacy and was included in Dr. Shelly Gray’s study at the University of Washington:

  • Amitriptyline (Elavil)
  • Atropine
  • Benztropine (Cogentin)
  • Chlorpheniramine (Actifed, Allergy & Congestion Relief, Chlor-Trimeton, Codeprex, Efidac-24
  • Chlorpheniramine, etc.)
  • Chlorpromazine (Thorazine)
  • Clomipramine (Anafranil)
  • Clozapine (Clozaril)
  • Cyclobenzaprine (Amrix, Fexmid, Flexeril)
  • Cyproheptadine (Periactin)
  • Desipramine (Norpramin)
  • Dexchlorpheniramine
  • Dicyclomine (Bentyl)
  • Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep,
  • Sominex, Tylenol PM, Unisom, etc.)
  • Doxepin (Adapin, Silenor, Sinequan)
  • Fesoterodine (Toviaz)
  • Hydroxyzine (Atarax, Vistaril)
  • Hyoscyamine (Anaspaz, Levbid, Levsin, Levsinex, NuLev)
  • Imipramine (Tofranil)
  • Meclizine (Antivert, Bonine)
  • Nortriptyline (Pamelor)
  • Olanzapine (Zyprexa)
  • Orphenadrine (Norflex)
  • Oxybutynin (Ditropan, Oxytrol)
  • Paroxetine (Brisdelle, Paxil)
  • Perphenazine (Trilafon)
  • Prochlorperazine (Compazine)
  • Promethazine (Phenergan)
  • Protriptyline (Vivactil)
  • Pseudoephedrine HCl/Triprolidine HCl (Aprodine)
  • Scopolamine (Transderm Scop)
  • Thioridazine (Mellaril)
  • Tolterodine (Detrol)
  • Trifluoperazine (Stelazine)
  • Trimipramine (Surmontil)

Other Anticholinergic Drugs (with lesser AC effect)

Here are some other anticholinergic drugs to watch out for. Generally, they have a weaker anticholinergic effect. Still, you should be mindful of using these drugs, especially if you are already taking another anticholinergic.

  • Alprazolam (Xanax)
  • Amantadine (Symmetrel)
  • Baclofen
  • Carisoprodol (Soma)
  • Cetirizine (Zyrtec)
  • Cimetidine (Tagamet)
  • Clorazepate (Tranxene)
  • Codeine
  • Colchicine
  • Digoxin (Lanoxicaps, Lanoxin)
  • Diphenoxylate (Lomotil)
  • Fluphenazine (Prolixin)
  • Furosemide (Lasix)
  • Hydrochlorothiazide (Esidrix, Dyazide, HydroDIURIL, & Maxzide)
  • Loperamide (Imodium)
  • Loratadine (Alavert, Claritin)
  • Maprotiline
  • Nifedipine (Adalat, Procardia)
  • Ranitidine (Zantac)
  • Thiothixene (Navane)
  • Tizanidine (Zanaflex)

Signs of a Possible Anticholinergic Overdose

If you’re taking any of the above drugs, contact a doctor immediately if you notice the following symptoms, as these can indicate a possible overdose:

  • Dizziness
  • Severe drowsiness
  • Fever
  • Severe hallucinations
  • Confusion
  • Trouble breathing
  • Clumsiness and slurred speech
  • Fast heartbeat
  • Flushing and warmth of the skin

Who Else Should Avoid Anticholinergics?

While elderly patients are more susceptible to the neurological toxicity of anticholinergic drugs, they are not the only ones who should avoid this type of medication.

You should also avoid anticholinergic drugs if you have:

  • Myasthenia gravis
  • Hyperthyroidism
  • Glaucoma
  • Enlarged prostate
  • Hypertension (high blood pressure)
  • Urinary tract blockage
  • Increased heart rate (tachycardia)
  • Heart failure
  • Severe dry mouth
  • Hiatal hernia
  • Severe constipation
  • Liver disease
  • Down syndrome

Anticholinergic Alternatives

The preceding lists of drugs above are daunting, and you might feel as though you’ll simply have to suffer through whatever condition they’ve been prescribed for.

Luckily, this is not the case! There are safe effective alternatives. Check with your doctor or pharmacist. Discuss your symptoms and get recommendations for other options that are safe for older adults.

Here are some safer alternatives to popular anticholinergics, based on a study published in the Journal of the American Geriatrics Society:

Anticholinergic Alternatives

Description High-Risk Anticholinergic Side Effects Safer Alternative
First-Generation Antihistamines
  • Brompheniramine
  • Carbinoxamine
  • Chlorpheniramine
  • Clemastine
  • Cyproheptadine
  • Dexbrompheniramine
  • Dexchlorpheniramine
  • Diphenhydramine (oral)
  • Dimenhydrinate
  • Doxylamine
  • Hydroxyzine
  • Meclizine
  • Promethazine
  • Triprolidine
  • Higher anticholinergic side effects in the elderly (confusion, dry mouth, constipation, urinary retention)
  • Clearance reduced with advanced age and tolerance develops when used as a hypnotic
  • Allergy: levocetirizine, cetirizine, loratidine, fluticasone nasal spray
  • Antiemetic: ondansetron, granisetron, prochlorperazine
  • Sleep: Rozerem (ramelteon), trazodone, mirtazapine, melatonin (OTC)
Anti-Parkinson Agents
  • Benztropine (oral)
  • Trihexyphenidyl
  • Higher anticholinergic side effects in elderly (confusion, dry mouth, constipation, urinary retention)
  • Clearance reduced with advanced age
  • carbidopa/levodopa, ropinirole, pramipexole, amantadine

The first step, as with anything related to medication, is to consult with your doctor. They will likely know of the risks associated with the elderly and anticholinergics. If you keep them informed of any additional medications that you’re taking, then you greatly cut down on the likelihood of an anticholinergic overdose.