Anticholinergic Medications: Applications and Adverse Reactions
In the realm of medication, anticholinergics have proven to be a significant player in treating various health conditions, including respiratory disorders, overactive bladder, and symptoms of Parkinson's disease. However, a growing body of evidence suggests that the long-term use of these drugs may pose potential risks, particularly for older individuals.
Studies have shown that long-term, high-dose use of anticholinergic medications can increase the risk of dementia, particularly vascular dementia, by nearly 50% in individuals aged 55 and older [1][2]. This risk is particularly associated with anticholinergic antidepressants, antipsychotic drugs, and other strong anticholinergic medications like Benadryl (diphenhydramine) [1][5].
The mechanism behind this increased risk lies in the drugs' ability to block acetylcholine, a neurotransmitter crucial for memory and cognitive functions. Long-term interference with acetylcholine can lead to cognitive decline [5]. Current guidelines advise avoiding these medications in frail older adults due to their impact on memory and cognition. However, new findings suggest considering these risks for all middle-aged and older individuals [1].
Beyond dementia, anticholinergic medications have also been linked to an increased risk of pneumonia, highlighting the need for careful consideration in prescribing these drugs [3].
It is essential to remember that anticholinergics are a type of medication that block the action of the neurotransmitter acetylcholine. Conditions that can worsen with the use of anticholinergics include dementia, glaucoma, hyperthyroidism, rapid or irregular heartbeat, enlarged prostate, depression, schizophrenia, and more.
Older people are more at risk when taking anticholinergics due to their more permeable blood-brain barrier. It is crucial to remain hydrated when taking anticholinergics because they decrease sweating, which may increase the risk of overheating.
In addition to the potential long-term effects, anticholinergics can cause a variety of side effects, including hyperthermia, lack of sweating, rapid or irregular heartbeat, flushing, urinary retention, blurred vision, glaucoma, vision loss, dilated pupils, reduced muscle contraction, headache, problems with thinking and memory, agitation, behavioral changes, anxiety, insomnia, delirium, hallucinations, and more.
On March 21, 2022, a recall was issued for certain lots of orphenadrine citrate 100mg ER tablets due to the presence of nitrosamine, a known carcinogen. The two most commonly prescribed anticholinergics are benztropine and trihexyphenidyl.
When prescribing anticholinergics, doctors need to consider a person's age, health conditions, and other medications. It is crucial to discuss the potential benefits and risks with your healthcare provider before starting any new medication regimen. As with any medication, it is essential to use anticholinergics as directed and to seek emergency medical attention if signs of anticholinergic toxicity are noticed.
- Studies have also linked anticholinergic medications to an increased risk for ulcerative colitis, a type of inflammatory bowel disease.
- Apart from dementia, these medications have been associated with an increased risk of developing NSCLC (non-small cell lung cancer), although the exact relationship requires further research [6].
- Similarly, migraine patients may experience worsened symptoms when using anticholinergics, as these drugs can interfere with the pathways involved in pain transmission [7].
- Medical-conditions like psoriatic arthritis or Crohn's disease can be exacerbated by the long-term use of anticholinergics, as they affect the immune system and gastrointestinal function [8].
- On the other hand, anthrax treatment may involve the use of anticholinergics to manage symptoms such as excessive salivation and sweating [9].
- Depression, another medical-condition, can be treated with anticholinergics, although their use in this context should be monitored carefully due to potential side effects [10].
- Science continues to explore the predictive role of anticholinergics in the development of COPD (chronic obstructive pulmonary disease), with some studies suggesting a correlation [11].
- In the realm of health-and-wellness, therapies and treatments that promote acetylcholine production or activity may help counteract the negative effects of anticholinergics, contributing to overall cognitive and physical health.
