As we age, our bodies change—and that means some medicines may affect us differently than they did when we were younger. One group of medicines to be careful with is anticholinergic drugs.
These drugs are often used to treat things like:
- Dizziness
- Overactive bladder
- Allergies
- Muscle spasms
- Depression
They work by blocking a chemical called acetylcholine, which helps with memory, muscle movement, and other body functions.
Why Are These Drugs Risky for Older Adults?
For adults 65 and older, anticholinergic drugs can cause more side effects. These include:
- Memory problems
- Confusion
- Drowsiness
- Dry mouth
- Constipation
- Trouble urinating
- Blurry vision
These side effects can lead to falls, accidents, or make it harder to do everyday activities. The risk is even higher if you are taking more than one anticholinergic drug at the same time.
How Do I Know If I’m Taking One?
Some anticholinergic drugs need a prescription, but some are sold over-the-counter (OTC) at drugstores. This includes some sleep aids, allergy medications, and cold medicines.
Even if the label doesn’t say “anticholinergic,” the drug might still have these effects. That’s why it’s important to ask your doctor or pharmacist to review your medications with you. Below are common types of anticholinergic medicines you might want to reconsider (orange), unless there are no other options. Note this is not a complete list.
Common Anticholinergic Medicines and What They Are Used For
For Allergies
- Diphenhydramine (Benadryl, Banophen)
- Chlorpheniramine (Chlor-Trimeton)
- Clemastine (Tavist)
- Hydroxyzine
Other Options for Older Adults
- Loratadine (Claritin), Levocetirizine (Xyzal)
- Saline Nasal Rinse
- Nasal Steroid: Fluticasone (Flonase), Mometasone (Nasonex)
For Sleep Problems
- Doxylamine (Unisom, Generic Nighttime Sleep Aids)
- Diphendramine (Sominex, Tylenol PM, Generic PM Pain Relievers)
Other Options for Older Adults
- Melatonin, Low-dose Doxepin (3 to 6mg)
For Bladder Problems
- Oxybutynin (Ditropan)
- Trospium (Sanctura)
- Darifenacin (Enablex)
- Tolterodine (Detrol)
- Solifenacin (Vesicare)
- Flavoxate (Urispas)
Other Options for Older Adults
- Bladder training, avoid caffeine and alcohol, liit fluids before bedtime.
- Try long-acting bladder medications Vs Immediate-Release For Fewer Side Effects
- Trospium (Sanctura)- it does not easily enter the brain
- Mirabegron (Myrbetriq)
For Motion Sickness, Dizziness, Nausea
- Dimenhydrinate (Dramamine)
- Meclizine (Bonine, Dramamine II, Antivert)
- Promethazine (Phenergan)
- Prochlorperazine (Compazine)
Other Options for Older Adults
- Ondansetron (For Nausea)
For Antidepressants/Nerve Pain
- Amitriptyline (Elavil)
- Desipramine (Norpramin)
- Doxepin (>6mg/Day, Sinequan)
- Impramine (Tofranil)
- Nortriptyline (Pamelor)
- Paroxetine (Paxil)
Other Options for Older Adults
- For Depression: Sertraline, Citalopram, Bupropion, Venlafaxine, Duloxetine
- For Nerve Pain: Venlafaxine, Duloxetine, Gabapentin, Capsaicin Topical, Lidocaine Patch, Pregabalin
For Muscle Relaxants
- Cyclobenzaprine (Flexeril)
- Orphenadrine (Norflex)
Other Options for Older Adults
- Stretching, Physical Therapy, Therapeutic Massage.
- Acetaminophen, Salsalate, NSAID (Ibuprofen Or Naproxen, short term use only. Be cautious about long-term use; avoid if you have heart failure or kidney disease.)
For Parkinson Disease
- Benztropine (Cogentin)
- Trihexyphenidyl (Artane)
Other Options for Older Adults
- Carbidopa/levodopa
For Stomach Problems
- Dicyclomine (Bentyl)
- Hyoscyamine (Levslin)
- Homatropine (Hycodan, Hydromet)
- Chlordiazepoxide/Clidinium (Librax)
- Atropine (In Lomotil)
Other Options for Older Adults
- For Constipation: Peg3350 (Miralax), Psyllium (Metamucil)
- For Diarrhea: Loperamide
For Antipsychotics
- Chlorpromazine (Thorazine)
- Clozapine (Clozaril)
- Perphenazine (Trilafon)
- Olanzapine (Zyprexa)
Other Options for Older Adults
- Low dose Antipsychotic with lower anticholinergic activity (Risperidone, Aripiprazole, Ziprasidone, Quetiapine)
Tips to Stay Safe
If you need to take one of these medicines, here are some ways to lower the risk:
- Take the lowest dose that works
- Use it for the shortest time possible
- Try not to take more than one anticholinergic drug at once
- Review your medications regularly with your doctor or pharmacist
- Never stop a medicine without checking with your doctor first
Key Takeaway
Anticholinergic medications can be helpful for certain conditions, but they may carry more risks for adults 65 and older. Regularly reviewing your medications with a pharmacist or doctor can help you avoid unwanted side effects and find safer options when needed.
Disclaimer: This article is for informational purposes only and is not intended to substitute professional medical advice, diagnoses, or treatment. Always seek advice from your physicians or other qualified health provider prior to taking or stopping any medications.
Reference:
- 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023 July;71(7):2052-2081. doi: 10.1111/jgs.18372
- Hanlon JT, Semla TP, et al. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015;63(12):e8-e18.
