Anticholinergic medications should be stopped where possible.
- Anticholinergic medications work by decreasing the amount of cholinergic neurotransmitters available - these neurotransmitters are the very thing that medications such as Donepezil, which can slow the initial progression of dementia symtoms, are trying to enhance.
- Anticholinergics as a class of drugs can potentially contribute to a medication-induced cognitive impairment.
Drugs with a strong anti-cholinergic burden include:
- Drugs for bladder instability: oxybutin, solifenacin, tolterodine
The following medications can cause confusion and contribute to, or mimic, cognitive impairment:
- Anticonvulsants – all anticonvulsants can potentially impair cognitive function
- Antidepressants – risks highest in tricyclics. Withdrawal delirium also occurs
- Antipsychotics – those with considerable anticholinergic activity may worsen delirium
- Anti-parkinsonian drugs – risk highest in those with anticholinergic activity
- Cardiac drugs – including digoxin and calcium antagonists
- Corticosteroids – risk is dose related
- Hypnotics/Sedatives – more common with long-acting benzodiazepines
- Opioid analgesics – risk highest with pethidine