Anticholinergics: theoretical and clinical overview
Open accessAbstract
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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Preliminary data indicate that community exercise can be beneficial and engaging for young people with mental illness, including those with severe conditions.
“However, preliminary data indicates community exercise can be beneficial and engaging for young people with mental illness, even for those with severe conditions.253,254”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [254]
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Khan, W. U., Ghazala, Z., Brooks, H. J., Subramaniam, P., Mulsant, B. H., Kumar, S., Voineskos, A. N., Blumberger, D. M., Kern, R. S., & Rajji, T. K. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa093 · Cited by 27 · see citing works
- 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
- Publisher
- Informa UK Limited
- 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
- green
- figshare.com
- 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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