Incontinence Incontinence AntiMuscarinic (AntiCholinergic) Medication

What is it?

Amitriptyline (Triptafen,Elavil, Vanatrip)
OnabotulinumtoxinA (Botox)- skeletal muscle relaxant
Oxybutynin (Cystrin, Ditropan, Lyrinel XL, Kentera patches, Oxytrol, Gelnique)
Darifenacin (Emselex, Enablex)
Duloxetine (Yentreve/Cymbalta)
Fesoterodine (Toviaz)
Flavoxate (Urispas)
Mirabegron (Betmiga, Myrbetriq)
Propantheline Br. (Pro-banthine)
Propiverine HCL (Detrunorm)
Solifenacin Succinate (Vesicare, Vesomni)
Tolterodine (Detrusitol XL, Detrusitol, Detrol La)
Trospium chloride (Regurin, Sanctura XR )

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: Incontinence Incontinence 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).

NHS
Find information and advice on health conditions, symptoms, healthy living, medicines and how to get help (British National Health Service).
Medscape
Latest medical news and expert commentary in your specialty as well as disease information.
Pharmaceutical Journal
The Pharmaceutical Journal covers analysis, features, opinion, learning and careers articles, providing insight and knowledge about drugs, pharmacy practice, medicines use and healthcare policy in the context of the pharmacy profession and pharmaceutical science.
Healthline
Medical Information and health advice you can trust
ChatGPT
Get instant answers, find creative inspiration, and learn something new.
Medical News Today
Medical news and health news headlines posted throughout the day, every day.
WebMD
Better Information. Better Health.
Cleveland Clinic
Pushing the Standards of care.
Mayo Clinic
No.1 Hospital in the Nation (America)
Drugs.com
Know more. Be sure.
National Organisation of Rare Diseases
NORD is dedicated to supporting education, elevating care, advancing research, and driving policy for rare diseases.
Verywell Health
Know more. Fell better.
Fit for Travel
Information on how to stay safe and healthy abroad.
DR Axe
Health and fitness news. Recipes, Natural Remedies