Oh and if they prescribe you more than one serotonin manipulator without explaining the symptoms of serotonin syndrome or anything that adds up to 6 or more from www.psychconcierge.com/insights/ant... without explaining anticholinergic risk and warning signs--
Anticholinergic Burden: Clinical Reference Guide - PsychConcierge.com
This interactive chart offers a clear, clinician-informed tool for understanding anticholinergic burden across psychiatric and commonly co-prescribed medications. With color-coded tables, drug-specifi...
www.psychconcierge.com
February 24, 2026 at 1:56 PM
Oh and if they prescribe you more than one serotonin manipulator without explaining the symptoms of serotonin syndrome or anything that adds up to 6 or more from www.psychconcierge.com/insights/ant... without explaining anticholinergic risk and warning signs--
Recently saw anticholinergic toxicity in the ED. Physostigmine wasn’t available, so we used rivastigmine (6 mg caps & 13.3 mg patches) to reverse anticholinergic delirium/toxidrome—and it worked! #medsky #EMSky #Pharmsky #SkyRx
pmc.ncbi.nlm.nih.gov/articles/PMC...
pubmed.ncbi.nlm.nih.gov/38465631/
pmc.ncbi.nlm.nih.gov/articles/PMC...
pubmed.ncbi.nlm.nih.gov/38465631/
Rivastigmine Use in the Treatment of Antimuscarinic Delirium
pmc.ncbi.nlm.nih.gov
November 13, 2024 at 12:27 AM
Recently saw anticholinergic toxicity in the ED. Physostigmine wasn’t available, so we used rivastigmine (6 mg caps & 13.3 mg patches) to reverse anticholinergic delirium/toxidrome—and it worked! #medsky #EMSky #Pharmsky #SkyRx
pmc.ncbi.nlm.nih.gov/articles/PMC...
pubmed.ncbi.nlm.nih.gov/38465631/
pmc.ncbi.nlm.nih.gov/articles/PMC...
pubmed.ncbi.nlm.nih.gov/38465631/
What can I possibly know about anticholinergic biochemistry….. oh wait
April 8, 2026 at 2:38 PM
What can I possibly know about anticholinergic biochemistry….. oh wait
Patients on more anticholinergic meds had worse cognitive functioning in new study:
pubmed.ncbi.nlm.nih.gov/39820114
Here's the calculator they used to compute anticholinergic load:
acbcalc.com
pubmed.ncbi.nlm.nih.gov/39820114
Here's the calculator they used to compute anticholinergic load:
acbcalc.com
January 27, 2025 at 3:27 PM
Patients on more anticholinergic meds had worse cognitive functioning in new study:
pubmed.ncbi.nlm.nih.gov/39820114
Here's the calculator they used to compute anticholinergic load:
acbcalc.com
pubmed.ncbi.nlm.nih.gov/39820114
Here's the calculator they used to compute anticholinergic load:
acbcalc.com
and then guanfacine isn’t technically anticholinergic it just has all those same side effects for DIFFERENT reasons so people tend to call it anticholinergic when they’re talking about pharmacodynamic interactions
and my glycopyrrolate is topical so ¯\_(ツ)_/¯
and my glycopyrrolate is topical so ¯\_(ツ)_/¯
July 18, 2025 at 11:09 PM
and then guanfacine isn’t technically anticholinergic it just has all those same side effects for DIFFERENT reasons so people tend to call it anticholinergic when they’re talking about pharmacodynamic interactions
and my glycopyrrolate is topical so ¯\_(ツ)_/¯
and my glycopyrrolate is topical so ¯\_(ツ)_/¯
#anticholinergics
Study emphasises the importance of careful prescribing of anticholinergic drugs for patients with CKD.
Cognitive impairment, risks.
#pharmSky #MedSky
doi.org/10.1111/jgs....
Study emphasises the importance of careful prescribing of anticholinergic drugs for patients with CKD.
Cognitive impairment, risks.
#pharmSky #MedSky
doi.org/10.1111/jgs....
The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment
Background People with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on centra...
doi.org
December 4, 2024 at 9:13 PM
#anticholinergics
Study emphasises the importance of careful prescribing of anticholinergic drugs for patients with CKD.
Cognitive impairment, risks.
#pharmSky #MedSky
doi.org/10.1111/jgs....
Study emphasises the importance of careful prescribing of anticholinergic drugs for patients with CKD.
Cognitive impairment, risks.
#pharmSky #MedSky
doi.org/10.1111/jgs....
The fact they did not control for the underlying reasons renders the 2015 study utterly useless to determine if it's picking up the anticholinergic use or the underlying condition, and every replication since has repeated the mistake.
June 10, 2026 at 9:43 PM
The fact they did not control for the underlying reasons renders the 2015 study utterly useless to determine if it's picking up the anticholinergic use or the underlying condition, and every replication since has repeated the mistake.
She also started counseling me about being on “multiple anticholinergic drugs” and I was like “wait which ones?” and it turns out she had thought pyridostigmine was anticholinergic and she was really embarrassed and I was like, nooo don’t be! it’s SO rare to use cholinergic drugs besides Alzheimers
July 18, 2025 at 11:06 PM
She also started counseling me about being on “multiple anticholinergic drugs” and I was like “wait which ones?” and it turns out she had thought pyridostigmine was anticholinergic and she was really embarrassed and I was like, nooo don’t be! it’s SO rare to use cholinergic drugs besides Alzheimers
This study highlighted that anticholinergic and sedative medications to avoid in older people are still frequently prescribed despite the development and regular updating of potentially inappropriate medication criteria
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
Assessing the prevalence of anticholinergic and sedative medications to avoid in older adults from the French Health Data System
Background
In older people, medications with anticholinergic or sedative properties are associated with falls, frailty, and functional and cognitive impairment. These medications are often described.....
agsjournals.onlinelibrary.wiley.com
January 16, 2025 at 8:31 PM
This study highlighted that anticholinergic and sedative medications to avoid in older people are still frequently prescribed despite the development and regular updating of potentially inappropriate medication criteria
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
The Anticholinergic Burden (ACB) Calculator is a helpful tool to find out which meds have anticholinergic properties:
buff.ly/3QZXiuX
#Deprescribing is a helpful way to eliminate anticholinergic burden. Find helpful tools here:
buff.ly/48I6Ph9
buff.ly/3QZXiuX
#Deprescribing is a helpful way to eliminate anticholinergic burden. Find helpful tools here:
buff.ly/48I6Ph9
ACB Calculator
A tool for finding the ACB Score of commonly prescribed medicines, and for calculating the Anticholinergic Burden for your patient
buff.ly
February 28, 2025 at 5:01 PM
The Anticholinergic Burden (ACB) Calculator is a helpful tool to find out which meds have anticholinergic properties:
buff.ly/3QZXiuX
#Deprescribing is a helpful way to eliminate anticholinergic burden. Find helpful tools here:
buff.ly/48I6Ph9
buff.ly/3QZXiuX
#Deprescribing is a helpful way to eliminate anticholinergic burden. Find helpful tools here:
buff.ly/48I6Ph9
🔍 Our study highlights the frequent prescription of anticholinergic drugs in patients with chronic kidney disease (CKD) and their potential link to cognitive impairment.
📊 Graph: Therapeutic classes of anticholinergic drugs most commonly prescribed in the CKD-REIN cohort
📊 Graph: Therapeutic classes of anticholinergic drugs most commonly prescribed in the CKD-REIN cohort
The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment. #geriatrics #nephsky agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
December 10, 2024 at 9:48 AM
🔍 Our study highlights the frequent prescription of anticholinergic drugs in patients with chronic kidney disease (CKD) and their potential link to cognitive impairment.
📊 Graph: Therapeutic classes of anticholinergic drugs most commonly prescribed in the CKD-REIN cohort
📊 Graph: Therapeutic classes of anticholinergic drugs most commonly prescribed in the CKD-REIN cohort
🚨Only 3 Months of Anticholinergic use linked with 46% Higher Dementia Risk 🚨
Repost.
This meta-analysis (21 studies, 645K+ patients) finds long-term anticholinergic use (3+ months) significantly raises dementia risk—with strongest links to bladder, antidepressant & allergy meds.
Repost.
This meta-analysis (21 studies, 645K+ patients) finds long-term anticholinergic use (3+ months) significantly raises dementia risk—with strongest links to bladder, antidepressant & allergy meds.
February 11, 2025 at 8:26 PM
🚨Only 3 Months of Anticholinergic use linked with 46% Higher Dementia Risk 🚨
Repost.
This meta-analysis (21 studies, 645K+ patients) finds long-term anticholinergic use (3+ months) significantly raises dementia risk—with strongest links to bladder, antidepressant & allergy meds.
Repost.
This meta-analysis (21 studies, 645K+ patients) finds long-term anticholinergic use (3+ months) significantly raises dementia risk—with strongest links to bladder, antidepressant & allergy meds.
#anticholinergics
Dec 2024
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
Conclusions
The highest anticholinergic exposure was associated with greater white matter hyperintensity (WMH) burden
Dec 2024
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
Conclusions
The highest anticholinergic exposure was associated with greater white matter hyperintensity (WMH) burden
Cumulative anticholinergic exposure and white matter hyperintensity burden in community‐dwelling older adults
Background Anticholinergic exposure is associated with dementia risk; however, the mechanisms for this association remain unclear. The objective of this study was to examine the association between ...
agsjournals.onlinelibrary.wiley.com
January 3, 2025 at 4:03 PM
#anticholinergics
Dec 2024
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
Conclusions
The highest anticholinergic exposure was associated with greater white matter hyperintensity (WMH) burden
Dec 2024
agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
Conclusions
The highest anticholinergic exposure was associated with greater white matter hyperintensity (WMH) burden
Anticholinergic rant time 📯
Oxybutynin, solifenacin and tolterodine significantly increase the risk of dementia. Trospium does not. However, non-CNS side effects (urinary retention, constipation, dry mouth, rapid HR) still likely in all of them and must not be ignored!
#deprescribing
#ACB
#MedSky
Oxybutynin, solifenacin and tolterodine significantly increase the risk of dementia. Trospium does not. However, non-CNS side effects (urinary retention, constipation, dry mouth, rapid HR) still likely in all of them and must not be ignored!
#deprescribing
#ACB
#MedSky
Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study
Objective To investigate whether different anticholinergic drug treatments for overactive bladder have differential risks for incident dementia, in a large representative population of older adults in...
bmjmedicine.bmj.com
November 16, 2024 at 5:44 PM
Anticholinergic rant time 📯
Oxybutynin, solifenacin and tolterodine significantly increase the risk of dementia. Trospium does not. However, non-CNS side effects (urinary retention, constipation, dry mouth, rapid HR) still likely in all of them and must not be ignored!
#deprescribing
#ACB
#MedSky
Oxybutynin, solifenacin and tolterodine significantly increase the risk of dementia. Trospium does not. However, non-CNS side effects (urinary retention, constipation, dry mouth, rapid HR) still likely in all of them and must not be ignored!
#deprescribing
#ACB
#MedSky
Last week, I talked at RCPsych about antidepressants in older ppl.
- always consider psychological therapy as an adjunct/alternative(access/provision are challenges)
- SSRIs 1st line
- Start low, go slow but do go
- risk factors for hyponatraemia
- check anticholinergic drugs
#medsky #psychsky
- always consider psychological therapy as an adjunct/alternative(access/provision are challenges)
- SSRIs 1st line
- Start low, go slow but do go
- risk factors for hyponatraemia
- check anticholinergic drugs
#medsky #psychsky
November 19, 2024 at 5:45 PM
don't forget "anticholinergic/deliriant" as well!
January 18, 2025 at 9:36 PM
don't forget "anticholinergic/deliriant" as well!
Optimist: The cup is half full
Pessimist: The cup is half empty
Geriatric Psychiatrist: Recommend discontinuing anticholinergic medications to address this confusion
Pessimist: The cup is half empty
Geriatric Psychiatrist: Recommend discontinuing anticholinergic medications to address this confusion
Optimist:The cup is half full
Pessimist: The cup is half empty
ER doc: Hang 20cc/kg of NS please while we figure out the underlying reason why its IVC is flat
Pessimist: The cup is half empty
ER doc: Hang 20cc/kg of NS please while we figure out the underlying reason why its IVC is flat
Optimist: The cup is half full.
Pessimist: The cup is half empty.
Immigration law professor: In a thinly reasoned 6-3 decision, the Supreme Court has ordered that the contents of the cup be dumped into the sea.
Pessimist: The cup is half empty.
Immigration law professor: In a thinly reasoned 6-3 decision, the Supreme Court has ordered that the contents of the cup be dumped into the sea.
November 24, 2024 at 1:22 AM
Optimist: The cup is half full
Pessimist: The cup is half empty
Geriatric Psychiatrist: Recommend discontinuing anticholinergic medications to address this confusion
Pessimist: The cup is half empty
Geriatric Psychiatrist: Recommend discontinuing anticholinergic medications to address this confusion
My Frailty - Overprescribing - Anticholinergic talk for Imperial College Health Partners
Available here : vimeo.com/1020912980?share=copy#t=161.929
@Ldn_ICHP Polypharmacy page ➡️
imperialcollegehealthpartners.com/resource/polypharmacy-supporting-patients/
#PharmSky
Available here : vimeo.com/1020912980?share=copy#t=161.929
@Ldn_ICHP Polypharmacy page ➡️
imperialcollegehealthpartners.com/resource/polypharmacy-supporting-patients/
#PharmSky
November 16, 2024 at 8:38 AM
My Frailty - Overprescribing - Anticholinergic talk for Imperial College Health Partners
Available here : vimeo.com/1020912980?share=copy#t=161.929
@Ldn_ICHP Polypharmacy page ➡️
imperialcollegehealthpartners.com/resource/polypharmacy-supporting-patients/
#PharmSky
Available here : vimeo.com/1020912980?share=copy#t=161.929
@Ldn_ICHP Polypharmacy page ➡️
imperialcollegehealthpartners.com/resource/polypharmacy-supporting-patients/
#PharmSky
Anticholinergic meds are associated with poor cognition in schizophrenia, further confirmed by new 21-year study:
pubmed.ncbi.nlm.nih.gov/38237360
Learn more on reducing the anticholinergic load in the Carlat psychopharm textbook:
amzn.to/48yb7Y5
pubmed.ncbi.nlm.nih.gov/38237360
Learn more on reducing the anticholinergic load in the Carlat psychopharm textbook:
amzn.to/48yb7Y5
March 1, 2025 at 10:40 PM
Anticholinergic meds are associated with poor cognition in schizophrenia, further confirmed by new 21-year study:
pubmed.ncbi.nlm.nih.gov/38237360
Learn more on reducing the anticholinergic load in the Carlat psychopharm textbook:
amzn.to/48yb7Y5
pubmed.ncbi.nlm.nih.gov/38237360
Learn more on reducing the anticholinergic load in the Carlat psychopharm textbook:
amzn.to/48yb7Y5
The anticholinergic burden of the second generation nonsedating H1 antihistamines is almost nonexistent, and I am *still* not convinced about the long term risk of diphenhydramine being causation and not correlation
February 24, 2026 at 7:57 AM
The anticholinergic burden of the second generation nonsedating H1 antihistamines is almost nonexistent, and I am *still* not convinced about the long term risk of diphenhydramine being causation and not correlation
Interesting paper on the Risk of Dementia associated with anticholinergic medicines used for overactive bladder bmjmedicine.bmj.com/content/3/1/...
Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study
Objective To investigate whether different anticholinergic drug treatments for overactive bladder have differential risks for incident dementia, in a large representative population of older adults in...
bmjmedicine.bmj.com
November 15, 2024 at 8:11 AM
Interesting paper on the Risk of Dementia associated with anticholinergic medicines used for overactive bladder bmjmedicine.bmj.com/content/3/1/...
💡 "Anticholinergic Burden" refers to the cumulative anticholinergic effect of all medications taken by an individual.
A helpful systematic review has compiled available anticholinergic burden scales, comparing them based on factors such as included medications & scoring systems:
buff.ly/ExUaJoT
A helpful systematic review has compiled available anticholinergic burden scales, comparing them based on factors such as included medications & scoring systems:
buff.ly/ExUaJoT
March 4, 2026 at 5:01 PM
💡 "Anticholinergic Burden" refers to the cumulative anticholinergic effect of all medications taken by an individual.
A helpful systematic review has compiled available anticholinergic burden scales, comparing them based on factors such as included medications & scoring systems:
buff.ly/ExUaJoT
A helpful systematic review has compiled available anticholinergic burden scales, comparing them based on factors such as included medications & scoring systems:
buff.ly/ExUaJoT
Oh you laugh, but actually nutmeg (often but not always a component of pumpkin spice) is an anticholinergic, the literal opposite of a nerve agent.
I bring receipts pmc.ncbi.nlm.nih.gov/articles/PMC...
I bring receipts pmc.ncbi.nlm.nih.gov/articles/PMC...
Nutmeg Poisoning With Electrolyte Abnormalities: A Case Report
Nutmeg is a commonly used spice that contains myristicin, a compound with anticholinergic and psychoactive properties. Excessive consumption can lead to toxicity, causing psychiatric and anticholinerg...
pmc.ncbi.nlm.nih.gov
October 16, 2025 at 4:26 PM
Oh you laugh, but actually nutmeg (often but not always a component of pumpkin spice) is an anticholinergic, the literal opposite of a nerve agent.
I bring receipts pmc.ncbi.nlm.nih.gov/articles/PMC...
I bring receipts pmc.ncbi.nlm.nih.gov/articles/PMC...
