Klin Farmakol Farm. 2011;25(3):126-130

Anticholinergic effects of drugs in elderly patients

Agáta Mačugová¹, Magdaléna Kuželová², Lenka Kostková¹, Veronika Drobná¹, Ján Luha³, Andrej Dukát⁴, Ján Murín⁵, Kamil Stratený¹, Martin Wawruch¹

¹ Ústav farmakológie a klinickej farmakológie, Lekárska fakulta, Univerzita Komenského, Bratislava

² Katedra farmakológie a toxikológie, Farmaceutická fakulta UK, Bratislava

³ Ústav lekárskej biológie, genetiky a klinickej genetiky, Lekárska fakulta, Univerzita Komenského, Bratislava

⁴ II. interná klinika, Lekárska fakulta, Univerzita Komenského, Bratislava

⁵ I. interná klinika, Lekárska fakulta, Univerzita Komenského, Bratislava

Elderly patients represent a special group of population regarding the occurrence of adverse drug reactions. The adverse drug reactions

often remain unrecognised due to their non-characteristic symptoms and polymorbidity of elderly patients. In case of manifestation of

adverse drug reaction sometimes additional medication is added instead of adjustment of the dose of drug or its withdrawal. Anticholinergic

effects of medications represent a typical example of such often unrecognised adverse drug reactions. These drugs may cause

peripheral adverse drug reactions, e.g. dry mouth, constipation, urinary retention, tachycardia, mydriasis, inability to accommodate,

increased intraocular pressure or decreased secretion of sweat glands. Anticholinergic effects of medications on the central nervous

system may be a cause of sedation, worsening of cognitive functions or delirium. Many drugs show anticholinergic properties, however

in most cases these effects are not responsible for the mechanism of therapeutic action (e.g. amitriptyline, clozapine). The appropriate

identification of drugs with anticholinergic effects represents the basic condition for the reduction of anticholinergic burden of elderly

patients. There are several laboratory in vitro methods. The most important limitation of these methods is a complicated interpretation

of their results in clinical practice. The lists of drugs with anticholinergic properties represent a tool easily applicable in daily clinical

practice. The creation of such lists is based on the consensus of experts who take into consideration the literature data on individual

drugs as well as their own clinical experience. The aim of our article was to introduce the topic of anticholinergic effects of drugs. The

stress is put on the consequences of their manifestation as adverse drug reactions. The opportunities of identification of medications

with anticholinergic properties are described.

Keywords: anticholinergic, adverse effects, drugs, lists, withdrawal syndrome

Published: December 1, 2011  Show citation