Anticholinergic Drugs May Cause Serious Side Effects
Research increasingly points to an association between anticholinergic medications—a class of drugs commonly used by older adults—and an increased rate of emergency department and hospital utilization in the U.S.
Anticholinergic medications interfere with the actions of the neurotransmitter acetylcholine, which relays signals between brain cells to promote memory, attention, and many other brain functions. However, the body’s production of acetylcholine diminishes as we age, meaning that blocking it can result in a range of side effects in seniors. “These side effects are exacerbated because the liver and kidneys are less efficient at breaking down and excreting drugs as we get older,” explains Judith Beizer, PharmD, clinical professor at St. John’s University College of Pharmacy and Health Sciences. “The elderly also are more sensitive to the side effects of these agents because they tend to exacerbate existing conditions, such as constipation, or urinary retention in men with enlarged prostates.”
While it is the standard of care to avoid using anticholinergic drugs in the elderly, it is precisely this age group that is most likely to suffer from the conditions these drugs treat—for example, problems with bladder control, depression, and poor sleep. Studies suggest that as many as half of older adults in the U.S. are taking anticholinergics to treat these and other health issues, with many people regularly taking two or more.
Cumulative Effect A 2016 study (Pharmacotherapy, November) included 3,344 people age 65 and older. Those who took a mild anticholinergic drug each day had an 11 percent greater likelihood of inpatient admission over one year. Taking a drug with a strong anticholinergic effect each day increased the likelihood of inpatient admission by 33 percent over one year—but Beizer emphasizes that this was an association, not cause and effect. “Other things could underlie these data,” she explains. “The participants all had a range of common comorbidities, including heart failure, stroke, arthritis, diabetes, cancer, and cognitive impairment. It is possible their increased utilization of emergency departments and hospitals was due to the fact they were sicker to begin with.”
Physical and Mental Side Effects Physical side effects from anticholinergics include drowsiness, a dry mouth, blurred vision, constipation, urinary retention, decreased sweating, a raised body temperature, and an increased heart rate.Mental and cognitive side effects also may occur (for example, confusion, agitation, irritability, inability to focus, and memory lapses). A 2013 study carried out by the same investigators suggested that the likelihood of developing cognitive impairment increased by 100 percent in people who took one strong anticholinergic agent for more than 60 days, and by 50 percent in those who took at least three mild anticholinergic agents for more than 90 days.
Further evidence of the drugs’ adverse effects was reported in another 2016 study (JAMA Neurology, June), which shed light on how anticholinergic drugs act on the brain to increase the risk for cognitive problems in the elderly. Researchers used neuroimaging to show that the use of anticholinergic drugs (compared with non-use) in cognitively normal older adults correlated with increased brain atrophy, and poorer memory and executive function (the ability to plan, organize and pay attention to what you’re doing).
Get Informed About the Drugs You Take Beizer recommends that you get informed about any and all medications you are taking. Read the medication guide (see our January issue for more on these), and if you are at all unsure about the effects of a drug you are taking, or why you are taking it, ask your pharmacist or doctor. “It is particularly important that you, your pharmacist, and your primary care physician keep track of what you are taking if you use several medications and see more than one doctor,” Beizer cautions.
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