Anticholinergic medicines – weighing up the risks
Hello, my name is Sarah Mitchell-Gears and I’m the principal pharmacist for older people’s mental health at Bradford District Care Trust. I also chair the West Yorkshire Anticholinergic Burden Task and Finish Group. We have done a lot of work in the region to raise awareness of anticholinergic medicines and their adverse side effects, particularly in older people living with frailty.
Acetylcholine is a chemical in the body that helps with many functions including saliva production, steadying the heart rate, controlling body temperature and staying alert. Some medicines work by blocking the action of acetylcholine, these are called ‘anticholinergic medicines’ or ‘anticholinergics’. Examples of anticholinergics include medicines for overactive bladder and some antidepressants. Many over the counter medicines, including some allergy treatments and non-prescription sleeping tablets are also anticholinergics.
Because acetylcholine is present in many parts of the body, taking a medicine to block it can impact on a range of bodily functions. Those taking an anticholinergic may experience side effects including dry mouth, rapid heart rate, urinary retention, constipation and drowsiness. The risk of side effects is increased if people are taking multiple anticholinergics, taking them at higher doses or taking them for a long time. This is referred to as the ‘anticholinergic burden’. It particularly impacts older people who are more likely to have multiple health conditions that can be treated with anticholinergics.
The West Yorkshire Anticholinergic Burden Task and Finish Group is supporting patients and healthcare professionals to understand the importance of reducing anticholinergic burden. The group has developed a web page of information about anticholinergic medicines and how people can lower the risk of getting side effects. This information can be translated into over 100 languages using the website’s translation function. On the web page you can find a patient information leaflet and an easy read version to read online or print out.
For healthcare professionals, we’ve included some prescribing guidance to support the safe and effective use of anticholinergics, and we’ve worked with Health Innovation Network Yorkshire and Humber to produce anticholinergic burden masterclasses. These are available via the following links:
- Anticholinergic burden of medicines masterclass
- Managing anticholinergic burden – top tips and practicalities
To further raise awareness among healthcare professionals and patients, I was joined by Eleanor Barnes to record a podcast. Eleanor, who is the Lead Pharmacist for a GP federation in Bradford, explains what anticholinergics are and how the anticholinergic burden is calculated. She also talks about the fascinating origins of these medicines, the different health conditions they can help with, and the most common side effects including the potential links between anticholinergic medicines and dementia. Listen to the Talking about anticholinergic medicines podcast to find out more.
Anticholinergics help countless people manage a range of health conditions, but they may not be suitable for everyone and may not be suitable for people to take forever. People who are taking anticholinergics, and who are experiencing side effects or have any concerns, should talk to their doctor, nurse or pharmacist before stopping or changing any medicines. The doctor or pharmacist will be able to assess the anticholinergic burden of an individual’s medication and make recommendations to reduce the risk of adverse effects.
Thank you for reading
Sarah