Decoding Anticholinergic Drugs: Uses, Safety, and More

Ross Phan, PharmD, BCACP, BCGP, BCPS
·6 min read

For Medical Conditions Relating to the Bladder, Digestive System, Brain, and More

Medically reviewed by Femi Aremu, PharmD

Anticholinergic drugs treat various medical conditions relating to the bladder, digestive system, brain, and more. While this drug class has many uses, it also has several possible side effects, including dry mouth, constipation, and vision problems.

This article discusses what you should know about the anticholinergic drug class in terms of its uses, side effects, and how these drugs work.

What Are Anticholinergic Drugs?

The large anticholinergic drug class consists of several medications that generally work by blocking acetylcholine (ACh) activity. Acetylcholine is a naturally occurring chemical in the body.

In addition to interfering with acetylcholine activity, many of these medications have other mechanisms of action (ways they work) to treat various medical conditions. This means that some of these medications are in other drug classes as well as being part of the anticholinergic drug group.

<p>Natee Meepian / Getty Images</p> Female reading pharmacy label

Natee Meepian / Getty Images

Female reading pharmacy label

What Conditions Do Anticholinergic Drugs Treat?

In general, anticholinergic drugs are used to treat a diverse range of medical conditions. Some examples are:

Other than motion sickness, some anticholinergic drugs may also be used to treat the following brain-related and mental health conditions:

This is not a complete list of medical conditions that anticholinergic drugs treat. Reach out to a healthcare provider or pharmacist to learn how these drugs may treat your medical conditions.

List of Anticholinergic Drugs

Anticholinergic drugs are available as over-the-counter (OTC) medications and prescription products.

Examples of some OTC anticholinergic drugs are:

As for prescription anticholinergic drugs, examples are:

  • Bladder-related medications, such as Oxytrol (oxybutynin) and Detrol (tolterodine)

  • Heart medications, such as Cardizem (diltiazem), Thalitone (chlorthalidone), and Lasix (furosemide)

  • Pain medications, including opioids

A number of anticholinergic prescriptions also include the following inhalers:

  • Atrovent HFA (ipratropium)

  • Incruse Ellipta (umeclidinium)

  • Spiriva HandiHaler (tiotropium)

  • Tudorza Pressair (aclidinium)

Moreover, prescriptions with anticholinergic activity consist of the following brain-related or mental health medications:

  • Amitriptyline

  • Benztropine

  • Clozaril (clozapine)

  • Gocovri (amantadine)

  • Haldol (haloperidol)

  • Mirapex ER (pramipexole)

  • Paxil (paroxetine)

  • Prozac (fluoxetine)

  • Remeron (mirtazapine)

  • Seroquel (quetiapine)

  • Sinemet (carbidopa-levodopa)

  • Tegretol (carbamazepine)

  • Tofranil (imipramine)

  • Trazodone

  • Trileptal (oxcarbazepine)

  • Vistaril (hydroxyzine)

  • Zelapar (selegiline)

  • Zoloft (sertraline)

  • Zyprexa (olanzapine)

This is not a complete list of anticholinergic drugs. If you're unsure whether your medication is an anticholinergic drug, talk to a healthcare provider or pharmacist.

Side Effects

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects.

If you experience other effects while taking an anticholinergic drug, contact a pharmacist or healthcare provider.



Explainer

You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.



Mild or moderate side effects of anticholinergic drugs may include:

Potentially serious side effects of anticholinergic drugs may include:

In general, anticholinergic drugs may have numerous side effects depending on factors such as anticholinergic activity or long-term use of a medication. Moreover, based on individual characteristics, anticholinergic drugs might have more of an effect on you.

For example, anticholinergic drugs may increase the risk of psychosis in people with Alzheimer's disease. As for people with schizophrenia who are already at risk of having early cognitive impairment, even medications with a small amount of anticholinergic activity may have a considerable impact on mental abilities.

In older adults, there is also a possible link between anticholinergic drugs with:

  • Falls

  • Hospitalizations

  • Mortality (death)

In addition to these possible effects on some people, combining different medications with anticholinergic drugs can worsen anticholinergic side effects.

For these reasons, you must talk with a healthcare provider about all of your medical conditions. It's also good to make a healthcare provider and pharmacist aware of your medications, including prescriptions, over-the-counter (OTC) items, herbal products, supplements, and natural medications.

Get medical help immediately if you develop a severe allergic reaction or serious side effects. Call 911 if your symptoms feel life-threatening.

How Anticholinergics Work

In general, anticholinergic drugs work by blocking the activity of acetylcholine, which is a naturally occurring chemical. In the body, acetylcholine typically attaches to binding sites called muscarinic receptors.

This attachment leads to a signaling process that plays a role in various bodily functions, including:

  • Attention

  • Heart rate and rhythm

  • Learning

  • Memory

  • Movement of intestinal contents

  • Secretions like saliva (spit) and tears

  • Smooth muscle contraction

  • Urination (peeing)

  • Widening of blood vessels

Anticholinergic drugs inhibit these acetylcholine activities by adhering to the same muscarinic binding sites and preventing acetylcholine from attaching to these receptors. This, then, results in some of the following well-known anticholinergic side effects:

  • Blurry vision

  • Constipation

  • Dry mouth

  • Fast heart rate

  • Memory problems

  • Urinary retention

Nutrition Considerations

Combining different nutritional supplements, including some vitamins, with anticholinergics, may worsen anticholinergic side effects.

What's more, malnutrition is a potentially serious side effect of anticholinergic drugs. In fact, a study of 423 older adults observed a link between medications with high anticholinergic activity and malnutrition.

This possible relationship could be due to several reasons, including:

  • The anticholinergic side effect of dry mouth may result in taste changes and affect digestion.

  • A slower digestive system and fewer secretions may decrease appetite from feeling full faster.

  • The effect on mental abilities may result in swallowing problems, dehydration, and appetite loss.

Summary

The anticholinergic drug class is a large group of medications. On top of blocking the activity of a naturally occurring chemical called acetylcholine, many of these medications have other mechanisms of action to treat various medical conditions.

While the anticholinergic drug class has a wide range of uses, it is not without side effects. There are also potential interactions with certain medical conditions, other medications, and nutritional considerations.

To get the most out of the anticholinergic drug you take and limit its negative effects, consult a healthcare provider or pharmacist.

Frequently Asked Questions

What are anticholinergic drugs?

The anticholinergic drug class is a large group of medications. In addition to the activity of a naturally occurring chemical called acetylcholine, many of these medications have other mechanisms of action to treat various medical conditions.

What are three common anticholinergic drugs?

Some common anticholinergic drugs include Benadryl (diphenhydramine), Oxytrol (oxybutynin), and amitriptyline.

What are the anticholinergic drugs that cause dementia?

A 2019 study showed a link between dementia risk and the following anticholinergic drugs: antidepressants, anti-seizure medications, certain bladder-related medications, and Parkinson's disease medications.

Read the original article on Verywell Health.