Antimuscarinic Anticholinergic Medications in Parkinson Disease: To Prescribe or Deprescribe?

Abstract

The relative importance of antimuscarinic anticholinergic medications for Parkinson's disease (PD) declined after the introduction of levodopa, such that anticholinergic medications are now much more likely to be prescribed for clinical indications other than parkinsonism. Recent studies have found an association between anticholinergic medication exposure and future risk of dementia in older individuals and those with PD. These findings provide a further reason to avoid the use of anticholinergic medications to treat motor symptoms of PD. More importantly, they raise the question of whether one of the goals of PD treatment should be to deprescribe all medications with anticholinergic properties, regardless of their indication, to reduce dementia risk. In this review, we discuss the use of anticholinergic medications in PD, the evidence supporting the association between anticholinergic medications and future dementia risk, and the potential implications of these findings for clinical care in PD.

Call for Manuscripts

“…Anticholinergic medications are prescribed to treat various conditions, including chronic obstructive pulmonary disease, 33 asthma, 34 gastrointestinal disorders (vomiting), 35 cardiovascular disease, 36 and symptoms of Parkinson disease. 37 These anticholinergic medications inhibit exocrine gland secretion, which results in reduced salivation and xerostomia. Anticholinergic burden, as a cumulative effect of taking 1 or more drugs susceptible to inducing anticholinergic adverse effects, needs to be assessed to reduce adverse effects such as xerostomia.…”

Anticholinergic Burden and Xerostomia in Critical Care Settings

“…Anticholinergic medications are prescribed to treat various conditions, including chronic obstructive pulmonary disease, 33 asthma, 34 gastrointestinal disorders (vomiting), 35 cardiovascular disease, 36 and symptoms of Parkinson disease 37 . These anticholinergic medications inhibit exocrine gland secretion, which results in reduced salivation and xerostomia.…”

Emerging Therapeutic Strategies for Parkinson’s Disease and Future Prospects: A 2021 Update

“…Motor Dopamimetic drugs L-DOPA Dopamine agonists (ropinirole, pramipexole) [17] Prevention of L-DOPA/dopamine breakdown Decarboxylase inhibitors (carbidopa, benserazide); MAO-B inhibitors (selegiline, rasagiline, safinamide); COMT inhibitors (entacapone, opicapone) [8] Glutamate inhibition Amantadine [18] Restoration of the balance between dopamine and acetylcholine Anticholinergics (benztropine, procyclidine, trihexyphenidyl) [13] Surgery Deep brain stimulation; MRgFUS [14,15] Non-motor Depending on the symptoms, antidepressants, cholinesterase inhibitors, or sedative agents may be used [16] PD: Parkinson's disease, MAO-B: monoamine oxidase-B, COMT: catechol-O-methyl transferase, MRgFUS: magnetic resonance-guided focused ultrasound ablation.…”

“…Low doses of glutamate antagonists have been shown to slow the progression of PD by reducing DA denervation in the striatum [ 12 ]. Anticholinergics which restore the balance between dopamine and acetylcholine in the striatum may be beneficial to reduce tremors associated with PD, especially in the early stages [ 13 ].…”