Medications with Significant Anticholinergic Properties

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MEDICATIONS WITH SIGNIFICANT ANTICHOLINERGIC PROPERTIES
Therapeutic Categories (Drug List*) Potential Adverse Consequences

Antihistamines

• chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine

Increased blood pressure

 

Breathing difficulty changes

 

Clumsiness or unsteadiness

 

Convulsions

 

Digestive system changes, eg,

• Bloating

• Decreased bowel motility

• Constipation

• Paralytic/adynamic ileus

• Nausea or vomiting

• Swallowing difficulty with dry mouth

 

Mental status/behavior changes, eg,

• Distress, excitement, nervousness

• Impaired attention

• Cognitive decline

• Confusion/disorientation

• Hallucinations

• Memory loss

• Restlessness or irritability

 

Delirium

 

Dizziness or Drowsiness

 

Fever

 

Headache

 

Increased heart rate

 

Lethargy, fatigue

 

Mucous membrane dryness: mouth, nose 

 

Severe muscle weakness

 

Slurring speech

 

Skin changes

• Dryness

• Decreased sweating

• Flushing

• Excessive warmth

 

Vision impairment, changes in acuity

• Blurring

• Worsening glaucoma

• Eye pain

• Light sensitivity

 

Urinary retention or difficulty

Antidepressants

• amoxapine, amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, paroxetine

Antiemetics

• prochlorperazine, promethazine

Antipsychotics

• chlorpromazine, clozapine, olanzapine, thioridazine

Antivertigo

• meclizine, scopolamine

Cardiovascular

• furosemide, digoxin, nifedipine, disopyramide

Gastrointestinal

• Antidiarrheal: diphenoxylate atropine

• Antispasmodics: belladonna, clidinium, chlordiazepoxide, dicyclomine, hyoscyamine, propantheline

• Antiulcer: cimetidine, ranitidine

Muscle Relaxants

• cyclobenzaprine, dantrolene, orphenadrine

Parkinsonism

• amantadine, benztropine, biperiden, trihexyphenidyl

Urinary Incontinence

• oxybutynin, propantheline, solifenacin, tolterodine, trospium

 Therapeutic Categories (Drug List*)

 

 Antihistamines

• chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine

 Antidepressants

• amoxapine, amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, paroxetine

 Antiemetics

• prochlorperazine, promethazine

 Antipsychotics

• chlorpromazine, clozapine, olanzapine, thioridazine

 Antivertigo

• meclizine, scopolamine

 Cardiovascular

• furosemide, digoxin, nifedipine, disopyramide

 Gastrointestinal

• Antidiarrheal: diphenoxylate atropine

• Antispasmodics: belladonna, clidinium, chlordiazepoxide, dicyclomine, hyoscyamine, propantheline

• Antiulcer: cimetidine, ranitidine

 Muscle Relaxants

• cyclobenzaprine, dantrolene, orphenadrine

 Parkinsonism

• amantadine, benztropine, biperiden, trihexyphenidyl

 Urinary Incontinence

• oxybutynin, propantheline, solifenacin, tolterodine, trospium

 Potential Adverse Consequences

 

 Increased blood pressure

 

 Breathing difficulty changes

 

 Clumsiness or unsteadiness

 

 Convulsions

 

 Digestive system changes, eg,

• Bloating

• Decreased bowel motility

• Constipation

• Paralytic/adynamic ileus

• Nausea or vomiting

• Swallowing difficulty with dry mouth

 

 Mental status/behavior changes, eg,

• Distress, excitement, nervousness

• Impaired attention

• Cognitive decline

• Confusion/disorientation

• Hallucinations

• Memory loss

• Restlessness or irritability

 

 Delirium

 

 Dizziness or Drowsiness

 

 Fever

 

 Headache

 

 Increased heart rate

 

 Lethargy, fatigue

 

 Mucous membrane dryness: mouth, nose 

 

 Severe muscle weakness

 

 Slurring speech

 

 Skin changes

• Dryness

• Decreased sweating

• Flushing

• Excessive warmth

 

 Vision impairment, changes in acuity

• Blurring

• Worsening glaucoma

• Eye pain

• Light sensitivity

 

 Urinary retention or difficulty

REFERENCES  

*Not an inclusive list.

Adapted from the CMS State Operations Manual: Appendix PP - Guidance to Surveyors for Long Term Care Facilities.

Available at: cms.hhs.gov/manuals/Downloads/
som107ap_pp_guidelines_ltcf.pdf
. Accessed 12/2014.

(Rev. 12/2014)

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