Anticholinergic Medication Use Guidelines

Introduction to Anticholinergic Medication Guidelines

The American Geriatrics Society recommends avoiding anticholinergic medications in older adults and postoperative patients due to significant risks of delirium, cognitive impairment, falls, and other serious adverse effects 1, 2

The American Geriatrics Society strongly advises against using anticholinergic medications in older surgical patients to prevent postoperative delirium, with the exception of patients requiring treatment to prevent withdrawal complications or severe allergic/transfusion reactions 1
The use of anticholinergics for preventing extrapyramidal side effects from antipsychotics is not recommended, and should be reserved for treating significant extrapyramidal symptoms when dose reduction and medication switching have failed 3, 4
For patients with neuromuscular disease and sialorrhea, a therapeutic trial of an inexpensive oral anticholinergic medication is suggested as first-line therapy, with continued use only if benefits outweigh side effects 5, 6

Older adults are particularly vulnerable to anticholinergic adverse effects due to baseline cognitive impairment and reduced physiologic reserve, and deprescribing anticholinergic medications can prevent falls and reverse cognitive decline 2

Anticholinergic medications can cause central nervous system effects such as agitated delirium, confusion, hallucinations, disorientation, anxiety, and seizures, as well as peripheral effects like dry mouth, dry eyes, constipation, and urinary hesitancy 2

The American Geriatrics Society recommends reviewing all medications for anticholinergic properties, prioritizing discontinuation of anticholinergics used to manage side effects of other drugs, and maintaining anticholinergics treating primary conditions while exploring alternatives 2
Reducing doses to minimum effective levels, using gradual tapering rather than abrupt cessation, and switching to alternative medications with lower anticholinergic activity are recommended strategies for reducing anticholinergic burden 2, 4

Immediately discontinuing the precipitating drug, providing supportive care, and administering physostigmine (a reversible anticholinesterase) can reverse both central and peripheral anticholinergic effects 2