Anticholinergic side effects are something that I see on nearly a daily basis.  I’ve become accustomed at identifying these and trying to come up with a game plan to minimize these adverse effects.  Here’s a few strategies for things I look out for on a medication list to try to help identify these adverse effects.

1. Dry eyes – asking about the use of artificial tears is a tell tale sign that a patient may or may not be having dry eyes.  Another medication I commonly look for here is Restasis.  Restasis is cyclosporin eye drops that are used for very severe dry eyes.  These eye drops are very expesive and anything we can do to avoid anticholinergic side effects could potentially prevent us from having to use these.
2. Constipation – Looking for the use laxatives on a medication list may help you identify if anticholinergic side effects are present.  Opioids are the other classic example that can really bind people up, but ensuring anticholinergics aren’t contributing as well is really important.
3. Cognition concerns – When you see a patient on dementia medications like donepizil or memantine, you need to make sure that anticholinergics are minimized.
4. Dry mouth – With dry mouth, I will usually ask about this and also see if the patient is using a saliva substitute type medication like Biotene.
5. Urinary retention – Reviewing a patient’s medications and identifying the use of alpha blockers or 5-alpha reductase inhibitors like tamsulosin and finasteride respectively is an important thing to do to ensure that we are not exacerbating urinary retention with the use of anticholinergics.

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