Anticholinergics in Older Adults- Avoid, Replace and Monitor

Many medicines have varying degrees of anticholinergic activity. Some of these drugs, particularly those with intermediate or low activity, are not commonly known to possess anticholinergic properties. Regardless of their anticholinergic potency, when used concurrently, they could collectively contribute to the anticholinergic burden in elderly patients. While most of the adverse effects from the anticholinergic burden are reversible upon withdrawal of the anticholinergics, some of the adverse effects on the central nervous system (CNS) may be permanent. Fortunately, for most of the indications for strong anticholinergics, safer alternatives, both non-pharmacological and pharmacological, are available. Therefore, strong anticholinergic should be avoided, especially in older patients already on multiple drugs with anticholinergic activity. This is particularly relevant to those with comorbidities that would put them at risk for the adverse anticholinergic effects. If the use of a drug with strong anticholinergic activity is necessary for an older patient, it should be given at the lowest effective dose for the shortest possible period. Last but not least, the risks and benefits of the drug should be reviewed regularly in a timely manner.