Cited by 167Pharmaceutical Practices and Patient OutcomesCholinesterase and Neurodegenerative DiseasesPain Management and Opioid Use

Anticholinergics: theoretical and clinical overview

Open access
Nishtala, Prasad S., Salahudeen, Mohammed Saji, Hilmer, Sarah N.·2016·Expert Opinion on Drug Safety

Abstract

INTRODUCTION: Anticholinergics are a class of medicines that block the neurotransmitter, acetylcholine, in the brain and peripheral tissues. Medicines with anticholinergic activity are widely prescribed for and used by older people for various medical conditions. One-third to one-half of the medicines commonly prescribed for older people have anticholinergic activity. Several studies have reported anticholinergic burden to be a predictor of cognitive and functional impairments in older people. AREAS COVERED: This article exemplifies the theoretical and clinical aspects of medicines with anticholinergic activity, including pharmacology (definition of medicines that possess anticholinergic activity, antimuscarinic receptors, therapeutic and adverse effects), epidemiology, measures and effects of cumulative anticholinergic burden in older adults, and clinical recommendations. In addition, the gaps in the literature have been identified for future research. EXPERT OPINION: Many medicines that are commonly prescribed to older people have a degree of anticholinergic activity that can contribute to anticholinergic burden. Anticholinergic burden, measured in several ways that consider number, dose and/or degree of anticholinergic activity of medicines, has shown to be a predictor of adverse health and functional outcomes. The anticholinergic burden on older people should be minimised by avoiding, reducing dose and deprescribing medicines with anticholinergic activity where clinically possible.

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Crossref · 10.1517/14740338.2016.1165664

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153 of 153 references verified0 citation errors · 0 not checkable

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Authors
Nishtala, P. S., Salahudeen, M. S., & Hilmer, S. N.
Affiliations
  • University of Otago (NZ)
  • The University of Sydney (AU)
Corresponding author
Nishtala, Prasad S.
Venue
Expert Opinion on Drug Safety
Published
2016-03-30
Volume
15
Issue
6
Pages
753-768
ISSN
  • 1474-0338 (ISSN-L)
  • 1744-764X
OpenAlex
W2321402924
Cited by
167
References
153
Citations by year
2026: 15 · 2025: 17 · 2024: 23 · 2023: 11 · 2022: 21 · 2021: 24 · 2020: 27 · 2019: 18 · 2018: 5 · 2017: 2 · 2016: 3 · 2014: 1
FWCI
0.95
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Expert Opinion on Drug Safety (publishedVersion)
  • PubMed (publishedVersion)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
anticholinergic agents, anticholinergic burden, acetylcholine, muscarinic receptors, older adults, polypharmacy, cognitive impairment, functional disability, deprescribing, adverse drug reactions
MeSH terms
Aged, Cognition Disorders, Dose-Response Relationship, Drug, Humans, Practice Patterns, Physicians', Cholinergic Antagonists

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