Anticholinergic Activity of 107 Medications Commonly Used by Older Adults

  title={Anticholinergic Activity of 107 Medications Commonly Used by Older Adults},
  author={Marci L. Chew and Benoit H. Mulsant and Bruce G. Pollock and Mark E. Lehman and Andrew J. Greenspan and Ramy A. Mahmoud and Margaret A. Kirshner and Denise Sorisio and Robert R Bies and Georges M. Gharabawi},
  journal={Journal of the American Geriatrics Society},
The objective of this study was to measure the anticholinergic activity (AA) of medications commonly used by older adults. [] Key Method A radioreceptor assay was used to investigate the AA of 107 medications. Six clinically relevant concentrations were assessed for each medication. Rodent forebrain and striatum homogenate was used with tritiated quinuclidinyl benzilate. Drug-free serum was added to medication and atropine standard-curve samples.

Limitations of the Anticholinergic Activity Assay and Assay-Based Anticholinergic Drug Scales.

Anticholinergic Activity of Commonly Prescribed Medications and Neuropsychiatric Adverse Events in Older People

Significant interactions were observed between age (≥65 years) and exposure to cimetidine, anticholinergic drugs, antipsychotics, and tricyclic antidepressants in modifying odds for reporting NPAEs, reinforcing the need for cautious use and monitoring of drugs with AA in older people.

Anticholinergics: theoretical and clinical overview

This article exemplifies the theoretical and clinical aspects of medicines with anticholinergic activity, including pharmacology, epidemiology, measures and effects of cumulative antICHolinergic burden in older adults, and clinical recommendations.

Paying attention to pharmacokinetic and pharmacodynamic mechanisms to progress in the area of anticholinergic use in geriatric patients.

If one agrees that antimuscarinic ADRs are probably dose-related, future studies must consider all drugs, administration routes, doses, muscarinic receptor affinity, DDIs, and brain access, as well as the ability to cross the blood-brain barrier.

Case report: asenapine and anticholinergic toxicity.

It is presented in this case to highlight the importance for clinicians to integrate history and bedside examination data with principles of pharmacology, and asenapine should be added to the list of compounds with recognized anticholinergic potential.

A Predictive In Vitro Model of the Impact of Drugs with Anticholinergic Properties on Human Neuronal and Astrocytic Systems

A co-culture of human-derived neurons and astrocytes derived from the NT2 cell line may be appropriate for further investigation of adverse anticholinergic effects of multiple medications, in order to inform clinical choices of suitable drug use in the elderly.

Anticholinergic burden: considerations for older adults

A brief clinical overview of the pharmacology of anticholinergic medications in the context of older adults is provided, approaches to measure antICHolinergic burden are summarised, and deprescribing strategies to manage anticholergic burden for older adults in clinical practice are discussed.

Practical Guidelines for the Use of Medications with Anticholinergic Activity and Benztropine in Adult Individuals with Intellectual Disabilities

These guidelines have been developed using the prescribing information and reviewing the available literature on relevant neuropsychiatric disorders in populations without ID and believe that these guidelines will provide a useful resource for clinicians who treat adult individuals with IDs.

Anticholinergic Exposure in a Cohort of Adults Aged 80 years and Over

The longitudinal study among Belgian community‐dwelling oldest old demonstrated great anticholinergic exposure, which was associated with increased risk of mortality and hospitalization after 18 months, and female gender, the level of multi‐morbidity and the number of medications were associated with antICHolinergic use.

Drugs with anticholinergic properties: a current perspective on use and safety

The neural pathways of the cholinergic system are described and the main clinical uses and adverse effects of anticholinergic agents with a focus on cognitive impairment are outlined, and safety monitoring is discussed.



A model of anticholinergic activity of atypical antipsychotic medications

Serum levels of anticholinergic drugs in treatment of acute extrapyramidal side effects.

There was a highly significant inverse correlation between the presence of acute extrapyramidal side effects due to neuroleptics and the serum levels of anticholinergics.

Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance.

The largest analysis of SAA and the first to examine its extent and relationship with cognitive performance in a community sample suggest that SAA can be detected in most older persons in the community and confirm that even low SAA is associated with cognitive impairment.

Serum Antimuscarinic Activity During Clozapine Treatment

Clozapine was associated with clearly higher antimuscarinic activity than other antipsychotics or low doses of antiparkinsonians and in vitro studies and new clinical studies are needed to verify whether norclozAPine may significantly contribute to antimus carinic activity during clozapines treatment.

Acetylcholine and Delirium

This chapter will briefly review the clinical studies focussing on measurement of serum levels of anticholinergic activity in delirious states and the most recent data investigates the impact of antICHolinergics on demented patients.

Measurement of oxybutynin and its N-desethyl metabolite in plasma, and its application to pharmacokinetic studies in young, elderly and frail elderly volunteers.

Results indicate that for frail elderly patients a lower initial starting dose of 2.5 mg OB given two or three times a day may provide adequate therapeutic blood levels of the drug.

Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients.

Exposure to ACH medications is independently and specifically associated with a subsequent increase inDelirium symptom severity in elderly medical inpatients with diagnosed delirium.

Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium.

Data indicate that patients taking multiple medications may be at increased risk for side effects from psychotropic drugs, most of which have anticholinergic effects.

Low-level serum anticholinergicity as a source of baseline cognitive heterogeneity in geriatric depressed patients.

Even very low SA may produce subtle decrements in memory performance, an area of cognition known to be highly sensitive to anticholinergic effects.

Pharmacokinetics of Mirtazapine from Orally Administered Tablets: Influence of Gender, Age and Treatment Regimen

In all groups, chronic dosing resulted in approximately 10 per cent higher plasma levels at steady state than those predicted from the single‐dose kinetic profile of mirtazapine, although statistically significant effects of gender and of age were observed.