Anticholinergic side effects occur when medications block acetylcholine, a neurotransmitter involved in muscle activity, digestion, and cognitive processes. While these medications treat various conditions, blocking acetylcholine can lead to unintended consequences. Common effects range from physical discomforts like dry mouth and constipation to serious issues such as confusion and impaired thinking.
The risk of these adverse effects is significantly higher for older adults, as the aging body is more sensitive to anticholinergic drugs. Older individuals often take multiple medications, increasing cumulative exposure and the potential for severe side effects, including cognitive decline and an increased risk of falls. Prevention focuses on minimizing drug exposure and proactively managing physical symptoms.
Collaborative Medication Review and Adjustment
The most direct way to prevent anticholinergic side effects is carefully managing medications with a healthcare provider. Many common prescriptions and over-the-counter (OTC) drugs have anticholinergic properties, even if that is not their primary purpose. Recognizing these high-risk medications is the first step in prevention.
Certain classes of medications are highly anticholinergic, such as first-generation antihistamines (e.g., diphenhydramine), tricyclic antidepressants, and some bladder control drugs. The cumulative effect of taking multiple drugs, even those with weak properties, can quickly lead to a high overall risk. Patients should discuss all medications, including occasional OTC sleep aids or allergy pills, with a doctor or pharmacist to identify potential contributors.
If a high-risk medication is identified, a healthcare professional can explore alternatives with lower or no anticholinergic activity. For instance, second-generation antihistamines are preferred for allergies due to their minimal effects compared to first-generation types. If alternatives are unsuitable, dose optimization may be considered, as anticholinergic effects are often dose-dependent.
A formal process called deprescribing involves the systematic review and reduction or stopping of medications that may be causing harm or are no longer necessary. This process must be supervised by a medical professional to ensure safety and prevent withdrawal symptoms. Reducing the overall number of medications, particularly those with anticholinergic properties, effectively lowers the risk of adverse effects.
Proactive Non-Drug Strategies for Common Effects
While medication adjustment addresses the root cause, non-pharmacological strategies can mitigate specific physical symptoms. These daily actions prevent minor discomforts from escalating into more serious complications. Dry mouth (xerostomia) is a frequent complaint resulting from reduced saliva production due to acetylcholine blockage.
Managing Dry Mouth (Xerostomia)
To manage xerostomia, frequent sips of water and sugar-free candies or gum stimulate saliva flow. Patients may also use artificial saliva substitutes, available as sprays or gels. Addressing dry mouth is important for comfort and for preventing dental issues, as saliva protects teeth from decay.
Preventing Constipation
Constipation is a common peripheral side effect because anticholinergic drugs slow the digestive tract. Prevention focuses on dietary and lifestyle modifications. This includes maintaining adequate fluid intake and increasing high-fiber foods. Regular physical activity also promotes normal bowel function and should be encouraged as a preventative measure.
Addressing Vision and Dizziness
Anticholinergics can interfere with eye function, causing blurred vision or difficulty focusing, and can cause dizziness. To counter dizziness, patients should practice slow and deliberate position changes when moving from sitting or lying down to standing. Using lubricating eye drops may help with dry eyes, though this should be discussed with a doctor. Ensuring good lighting at home helps prevent falls related to visual changes.
Avoiding Overheating
Anticholinergics impair the body’s ability to regulate temperature by decreasing sweating. Prevention of overheating (hyperthermia) involves staying cool and avoiding strenuous physical activity in hot environments. Wearing light clothing and ensuring access to air conditioning during warm weather are practical steps to prevent a dangerous rise in body temperature.
Assessing Your Anticholinergic Burden
Preventing severe anticholinergic complications requires awareness and monitoring, especially regarding cognitive function. Healthcare providers use Anticholinergic Burden (ACB) scales to quantify the cumulative risk from a patient’s total medication regimen. These scales assign a score, typically from zero to three, to each medication based on its anticholinergic strength, and the scores are summed up.
A high cumulative score suggests an increased risk of adverse outcomes, including confusion, falls, and cognitive decline. Understanding this concept helps patients appreciate that the risk comes from the combined effect of multiple drugs, not just a single pill. This knowledge empowers the patient to have a more informed discussion with their prescriber about reducing their overall burden.
Self-monitoring is a preventative step for early detection of cognitive changes, such as mild memory issues, difficulty concentrating, or increased drowsiness. Keeping a simple diary to track these symptoms and noting when they occur can provide valuable information to a doctor. Subtle shifts in mental clarity should be reported immediately, as they can be early signs of a more serious problem.
For older adults, involving family members or caregivers in monitoring is particularly important, as self-reporting of cognitive symptoms can be unreliable. Caregivers are often the first to notice subtle behavioral or cognitive shifts, such as increased confusion, agitation, or a change in sleep patterns. Their observations serve as a valuable early warning system, allowing for timely intervention to prevent the progression to delirium or severe cognitive impairment.