title: Central Anticholinergic Adverse Effects and Their Measurement.
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.
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio Campus, PO Box FIN-1627, 70211, Kuopio, Finland. Pasi.Lampela@uef.fi.|Finnish Student Health Service (FSHS), Kuopio, Finland. Pasi.Lampela@uef.fi.
authors.forename: Pasi
authors.initials: P
authors.lastname: Lampela
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Paajanen
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio Campus, PO Box FIN-1627, 70211, Kuopio, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
authors.affiliation: Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.|Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Huupponen
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D006801:Humans; D008333:Mandelic Acids / Q000009:adverse effects
chemical_list: D018680:Cholinergic Antagonists; D008333:Mandelic Acids; C005419:oxybutynin