MEDICATIONS WITH SIGNIFICANT ANTICHOLINERGIC PROPERTIES
 
Therapeutic Categories (Drug List*) Potential Adverse Consequences
Antihistamines
• chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine
Blood pressure, increased
Breathing difficulty, changes
Clumsiness or unsteadiness
Convulsions
Digestive system changes, e.g.,
• Bloating
• Bowel motility, decreased
• Constipation
• Ileus, paralytic/adynamic
• Nausea or vomiting
• Swallowing difficulty with dry mouth
Mental status/behavior changes, e.g.,
• Distress, excitement, nervousness
• Attention, impaired
• Cognitive decline
• Confusion/disorientation
• Hallucinations
• Memory loss
• Restlessness or irritability
Delirium
Dizziness or Drowsiness
Fever
Headache
Heart rate, increased
Lethargy, fatigue
Mucous membrane dryness: mouth, nose
Muscle weakness, severe
Speech, slurring
Skin, changes
• Dryness
• Sweating, decreased
• Flushing
• Warmth, excessive
Vision impairment, changes in acuity
• Blurring
• Glaucoma, worsening
• Eye pain
• Light sensitivity
Urinary retention or difficulty
Antidepressants
• amoxapine, amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, paroxetine
Antiemetics
• prochlorperazine, promethazine
Antipsychotics
• chlorpromazine, clozapine, olanzapine, thioridazine
Antivertigo
• meclizine, scopolamine
Cardiovascular
• furosemide, digoxin, nifedipine, disopyramide
Gastrointestinal
• Antidiarrheal: diphenoxylate atropine
• Antispasmodics: belladonna, clidinium, chlordiazepoxide, dicyclomine, hyoscyamine, propantheline
• Antiulcer: cimetidine, ranitidine
Muscle Relaxants
• cyclobenzaprine, dantrolene, orphenadrine
Parkinsonism
• amantadine, benztropine, biperiden, trihexyphenidyl
Urinary Incontinence
• oxybutynin, propantheline, solifenacin, tolterodine, trospium
NOTES

*Not an inclusive list.

Adapted from the CMS State Operations Manual: Appendix PP - Guidance to Surveyors for Long Term Care Facilities.

Available at: cms.hhs.gov/manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed 6/2007.

(Created 6/2007)