Incontinence Incontinence AntiMuscarinic (AntiCholinergic) Medication - Medtick
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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).

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