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Central Anticholinergic Adverse Effects and Their Measurement

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Abstract

Drugs with anticholinergic properties are widely used. However, they may evoke a variety of adverse reactions (such as dry mouth and constipation, but also drowsiness and confusion), and therefore unnecessary use of drugs with anticholinergic properties should be avoided. In particular, older people are particularly vulnerable to the central anticholinergic effects of drugs. However, monitoring of drug-induced anticholinergic effects and drug concentrations in serum is challenging. In addition to the ‘pure’ anticholinergics such as atropine and oxybutynin, several other drugs whose principal mode of action is not anticholinergic, possess anticholinergic properties, thus increasing the risk of anticholinergic adverse effects. In this paper, we focus on the central anticholinergic effects of drugs, and on the usefulness of the serum anticholinergic assay (SAA) in the prediction of anticholinergic effects. Results on the anticholinergic effects of drugs on cognition are mixed. This may be because of differences in the populations as well as in the drugs used. In addition, the clinical conditions of the patients may affect the results. The SAA has been used in an attempt to measure anticholinergic burden. However, the results are variable and the SAA levels do not necessarily reflect the medication used by the patient. Therefore, its usefulness in determining anticholinergic adverse reactions is questionable.

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Authors and Affiliations

  1. Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio Campus, PO Box FIN-1627, 70211, Kuopio, Finland

    Pasi Lampela & Sirpa Hartikainen

  2. Finnish Student Health Service (FSHS), Kuopio, Finland

    Pasi Lampela

  3. Finnish Institute of Occupational Health, Helsinki, Finland

    Teemu Paajanen

  4. Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland

    Risto Huupponen

  5. Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland

    Risto Huupponen

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  1. Pasi Lampela
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  2. Teemu Paajanen
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Correspondence to Pasi Lampela.

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This article was supported by a grant from the Päivikki and Sakari Sohlberg Foundation (PL).

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Pasi Lampela, Teemu Paajanen, Sirpa Hartikainen, and Risto Huupponen declare they have no conflicts of interest with the content of this article.

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Lampela, P., Paajanen, T., Hartikainen, S. et al. Central Anticholinergic Adverse Effects and Their Measurement. Drugs Aging 32, 963–974 (2015). https://doi.org/10.1007/s40266-015-0321-6

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