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References

World Health Organization. 2011. (Accessed on 27 May 2015)
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Mulsant BH, Pollock BG, Kirshner M, Shen C, Dodge H, Ganguli M Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch Gen Psychiatry. 2003; 60:198-203
Nabi G, Cody JD, Ellis G, Hay-Smith J, Herbison GP Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006; 4
Bostock CV, Soiza RL, Mangoni AA Association between prescribing of antimuscarinic drugs and antimuscarinic adverse effects in older people. Expert Rev Clin Pharmacol. 2010; 3:(4)441-452
Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE The Anticholinergic Risk Scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008; 168:(5)508-513
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Antimuscarinics in older people: dry mouth and beyond

From Volume 43, Issue 2, March 2016 | Pages 186-191

Authors

Clare Bostock

BMBCh, MA, MRCP(UK)

Consultant Geriatrician, Aberdeen Royal Infirmary

Articles by Clare Bostock

Christopher McDonald

MBChB, BDS, MFDS, MRCS RCS(Ed)

Specialty Trainee, Oral and Maxillofacial Surgery, Mersey Deanery

Articles by Christopher McDonald

Abstract

Many common prescription and over-the-counter medications have antimuscarinic effects. Antimuscarinics are a well recognized cause of dry mouth, with potential to cause other physical and cognitive adverse effects. A comprehensive medication review in a patient presenting with dry mouth can lead to overall health improvements. Scoring systems can be helpful in identifying antimuscarinic drugs and their adverse effects.

CPD/Clinical Relevance: Antimuscarinic drug use is prevalent and a common cause of dry mouth. Older people are particularly susceptible to antimuscarinic adverse effects.

Article

The number of older people worldwide is increasing. By 2050, 16% of the global population will be over 65.1 Approximately one-fifth of people in the United Kingdom are now aged 65 or older.2,3 Most people over 65 live with a long-term medical condition and most people over 75 live with two or more long-term medical conditions.4 Older people are more likely to take multiple medications. Around 20% of people over 70 take at least five medications, and 16% take 10 or more medications.4

Antimuscarinics are commonly prescribed drugs with significant oral effects. This is illustrated in the following case study and review. Following recognition of a drug-related oral problem, it is advisable to ask patients to attend their general medical practitioner for a medication review. A medication review is a ‘structured, critical examination of a patient’s medicines with the objective of reaching an agreement with the patient about treatment, optimizing the impact of medicines, minimizing the number of medication-related problems, and reducing waste'.5 Key points for general dental practitioners can be summarized as follows:

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