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Ask the Pharmacist
By Ron and Marla Chapleau

Health & Fitness

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Q: What is an anticholinergic and why is my pharmacist concerned that I am taking them?

A: Anticholinergics are medications that may cause dry mouth, constipation, urinary retention and in worst-case scenarios, cognitive impairment.  

These types of side-effects are particularly prevalent in the elderly and have the potential to significantly affect their quality of life as well lead to potential misdiagnoses.  Even being on one anticholinergic medication can increase the risk of decreased cognition by as much as 50 per cent, especially for people who have suffered a stroke or have a family history of dementia.  

It has also been found that anticholinergics are associated with higher hospitalization rates. Some medications have far more anticholinergic effects than others however.  

The tricky thing with anticholinergic drugs is that they are used for a wide variety of reasons and it is not unheard of to be on multiple drugs that have these effects. As such, avoiding them or at least minimizing them in seniors can be challenging.  

A brief summary of some of these drugs includes:

  • 1. The antihistamines (allergy remedies), particularly the older ones like Benadryl (diphenhydramine), chlorpheniramine and any night-time cold/flu medicine. 
  • 2. Tri-cyclic antidepressants such as amitriptyline (which is more often used for neuropathic pain or sleep rather than depression) and paroxetine (Paxil). Gabapentin or pregabalin may be better choices for neuropathic pain or other SSRIs for depression such as citalopram.  
  • 3. Medications used to treat an overactive bladder such as Ditropan (oxybutinin), Detrol (tolterodine) and Enablex (darifenacin) are well  known for their anticholinergic effects and often their minimal benefit does not outweigh these side effects.  
  • 4. Muscle relaxants such as Flexeril (cyclobenzaprine), Robaxacet (methocarbamol) are notorious for causing dry mouth and constipation as well.  

 
Anticholinergics may also interact with other medications, such as Aricept (and other similar Alzheimer’s type drugs), causing them to be less effective. Anticholinergics may also increase the risk of side-effects of some drugs such as the stomach effects associated with potassium supplements such as Apo- K.  

This is far from a full list of problematic medications so for more information on this or any other topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.


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Monday, December 26, 2011