Medication Review

Anticholinergic medications should be stopped where possible.

  • Anticholinergic medications work by decreasing the amount of cholinergic neurotransmitters available - these neurotransmitters are the very thing that medications such as Donepezil, which can slow the initial progression of dementia symtoms, are trying to enhance.  
  • Anticholinergics as a class of drugs can potentially contribute to a medication-induced cognitive impairment. 

Drugs with a strong anti-cholinergic burden include:

  • Drugs for bladder instability: oxybutin, solifenacin, tolterodine
  • Amitriptyline
  • Hydroxyzine

The following medications can cause confusion and contribute to, or mimic, cognitive impairment:

  1. Anticonvulsants – all anticonvulsants can potentially impair cognitive function
  2. Antidepressants – risks highest in tricyclics. Withdrawal delirium also occurs
  3. Antipsychotics – those with considerable anticholinergic activity may worsen delirium
  4. Anti-parkinsonian drugs – risk highest in those with anticholinergic activity
  5. Cardiac drugs – including digoxin and calcium antagonists
  6. Corticosteroids – risk is dose related
  7. Hypnotics/Sedatives – more common with long-acting benzodiazepines
  8. Opioid analgesics – risk highest with pethidine