Parkinson’s AntiMuscarinic (AntiCholinergic) Medication

What is it?

Benztropine (Cogentin)
Biperiden (Akineton)
Diphenhydramine (including all over the counter products i.e. Nytol, Compoz Nighttime Sleep Aid, Q-Dryl, Unisom SleepMelts, Sominex, Allermax, Dicopanol , Diphedryl , Diphenhist , Dytuss , Quenalin , Silphen Cough, Scot-Tussin Allergy , Siladryl Allergy , Tranquil Nighttime Sleep Aid , Sleepinal , Twilite , Valu-Dryl, Triaminic Thin Strips Cough & Runny Nose )
Orphenadrine HCL (Disipal, Biorphen liquid)
Procyclidine (Aprolin liquid, Kemadrin)
Trihexyphenidyl (Broflex, Benzhexol, Artane, Trihexane)

Complications /Information to beware of/General tips:

Side effects to watch for (see anti-cholinergic section):

Table. Differentiation of Serotonin Syndrome From Similarly Presenting Conditions

Clinical Feature	Serotonin Syndrome	Anticholinergic Toxidrome	Neuroleptic Malignant Syndrome	Malignant Hyperthermia
Medication history	Serotoninergic drug	Anticholinergic agent	Dopamine agonist	Inhalational anesthetic
Average onset time	< 12 h	< 12 h	1-3 d	0.5-24 h
Vital signs	Hypertension, tachycardia, tachypnea, fever (>105.8 °F [41 °C])	Hypertension, tachypnea, tachycardia, fever (<102.2 °F [39 °C])	Hypertension, tachycardia, tachypnea, fever (>105.8 °F [41 °C])	Hypertension, tachycardia, tachypnea, hyperthermia
Pupils	Mydriasis	Mydriasis	Normal	Normal
Bowel sounds	Hyperactive	Decreased or absent	Normal or decreased	Decreased
Tone	Increased in lower extremities	Normal	“Lead-pipe” rigidity in all muscle groups	Rigor mortis–like rigidity
Reflexes	Hyperreflexia clonus	Normal	Bradyreflexia	Hyporeflexia
Mental status	Agitation, coma	Agitation, delirium	Stupor, alert, mutism, coma	Agitation
Adapted from Boyer EW, Shannon M. N Engl J Med. 2005;352:1112-1120.

General Common side effects of anticholinergic include:

Dizziness;
Blurred vision;
Increased risk of falls;
Urinary retention;
Constipation;
Dry mouth;
Nausea;
Increased heart rate;
Dry eyes;
Narrow-angle glaucoma;
Sedation;
Vascular events;
Cognitive impairment;
Delirium;
Dementia;

8. Teoh CXW, Thng M, Lau S, et al. Dry mouth effects from drugs used for depression, anxiety, schizophrenia and bipolar mood disorder in adults: systematic review. BJPsych open. 2023;9. doi:10.1192/bjo.2023.15

9. British National Formulary. National Institute for Health and Care Excellence. 2022.https://bnf.nice.org.uk/ (accessed Aug 2023).

10. Kouladjian O’Donnell L, Gnjidic D, Nahas R, et al. Anticholinergic burden: considerations for older adults. J Pharm Pract Res. 2016;47:67–77. doi:10.1002/jppr.1303

12. O’Dwyer M, Maidment ID, Bennett K, et al. Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Br J Psychiatry. 2016;209:504–10. doi:10.1192/bjp.bp.115.173971

13.Ito K, Izumi N, Funayama S, et al. Characteristics of medication-induced xerostomia and effect of treatment. PLoS ONE. 2023;18:e0280224. doi:10.1371/journal.pone.0280224

17. Gray SL, Anderson ML, Dublin S, et al. Cumulative Use of Strong Anticholinergics and Incident Dementia. JAMA Intern Med. 2015;175:401. doi:10.1001/jamainternmed.2014.7663

The ACB calculator: Measuring anticholinergic side effects particularly for vulnerable groups (i.e. older, cognitive deficits, intellectual disability, mental health condition)

The ACB calculator

This calculator was created by using a combination of the German Anticholinergic Burden Score and the Anticholinergic Cognitive Burden Scale.

Krüger C, Schäfer I, van den Bussche H, et al. Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. BMJ Open. 2021;11:e044230. doi:10.1136/bmjopen-2020-044230

Bradshaw N. Anticholinergic cognitive burden (ACB) scale. GP Notebook. 2023.https://gpnotebook.com/simplepage.cfm?ID=x20140107154450216972 (accessed Aug 2023).

How to use?

Entering the name of the medication into the calculator automatically generates a score from 0 to 3.
Drugs with no anticholinergic effects score 0, drugs with possible anticholinergic effects score 1 and drugs with definite anticholinergic effects score 2 or 3.
A score of 3+ on this calculator is associated with increased cognitive impairment and mortality.

O’Dwyer M, Maidment ID, Bennett K, et al. Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Br J Psychiatry. 2016;209:504–10. doi:10.1192/bjp.bp.115.173971

Detailed Information

Please copy and paste any key words from the title: Parkinson’s AntiMuscarinic (AntiCholinergic) Medication in the following respective 'Medtick References and/or Sources' to find out more about the disease (this also may include diagnosis tests and generic medical treatments).

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