Overview
The Suboptimal Drug Selection – Multiple Anticholinergic Agents TIP was created to address the Pharmacy Quality Alliance measure Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH). Individuals 65 years of age or older are at a greater risk for side effects while taking two or more anticholinergic agents. The goal of the TIP is to consult the prescriber to discontinue or change therapy, so the patient is taking one or no anticholinergic medication.
Common Anticholinergic Agents
- Antidepressants
- Amitriptyline
- Amoxapine
- Clomipramine
- Desipramine
- Doxepin
- Imipramine
- Nortriptyline
- Paroxetine
- Antiemetic
- Prochlorperazine
- Promethazine
- Antihistamines
- Brompheniramine
- Chlorpheniramine
- Cyproheptadine
- Diphenhydramine
- Doxylamine
- Hydroxyzine
- Meclizine
- Triprolidine
- Antimuscarinics
- Darifenacin
- Fesoterodine
- Oxybutynin
- Solifenacin
- Tolterodine
- Trospium
- Antiparkinsonian Agents
- Benztropine
- Trihexyphenidyl
- Antipsychotics
- Chlorpromazine
- Clozapine
- Olanzapine
- Perphenazine
- Antispasmodics
- Atropine
- Clidinium-chlordiazepoxide
- Dicyclomine
- Homatropine
- Hyoscyamine
- Scopolamine
- Skeletal Muscle Relaxants
- Cyclobenzaprine
- Orphenadrine
Best Practices
When talking with the prescriber:
- Use the clinical guidelines and supporting evidence provided in the TIP overview.
- Have your recommendation ready, “Based on the other medications the patient is taking, I’d like to recommend (name of medication).”
- Keep the patient’s health at the center of the conversation−be prepared to defend your recommendation!
When talking with the patient:
- Discuss the benefits of using the suggested medication.
- Approach this as an “opportunity to improve your drug therapy” rather than a chance to “fix a mistake the prescriber has made.”
- Communicate the change to the patient after receiving the prescriber’s approval, “Here is a new medication your doctor has ordered for you.”
Resources:
- By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372