Table S1. Substitutes/Alternatives for Medicines with High Anticholinergic Activity
FIGURE LEGENDS
Electronic Supplementary Material Figure S1. Pocket Reference Card for Medicines with Anticholinergic Activity s (adapted from Salahudeen et al. [24], with permission). SSRI = selective serotonin reuptake inhibitor; SNRI = serotonin-norepinephrine reuptake inhibitor; MAOI = monoamine oxidase inhibitor; CCB = calcium channel blockers; ACEI = angiotensin-converting-enzyme inhibitor; COMT = catechol-O-methyl transferase.
Table S1. Substitutes/alternatives for medicines with high anticholinergic activity
Indication(s) / Medicines with high anticholinergic activity / Substitutes/alternative therapyAntihistamines
Allergic rhinitis and itching / First-generation: chlorpheniramine, brompheniramine, carbinoxamine, clemastine / Second-generation: cetirizine, loratadine, fexofenadine
Insomnia / First-generation: diphenhydramine, dimenhydrinate, hydroxyzine / Low dose TeCAs: trazodone, mirtazapine
Non-benzodiazepine sedative-hypnotic: eszopiclone, zolpidem
Non-pharmacological therapy such as eliminate caffeine, reduce daytime napping
Muscle relaxants
Overactive bladder / Antispasmodics: oxybutynin, darifenacin, flavoxate, propantheline, tolterodine / Non-pharmacological therapy such as Kegel exercises, scheduled toileting (timed or prompted voiding), and bedtime fluid/ caffeine restriction
Muscle spasm / Skeletal muscle relaxants: carisoprodol, cyclobenzaprine, methocarbamol / Non-pharmacologic therapy such as massage, physical therapy, application of heat/cold packs
Skeletal muscle relaxant: baclofen
Appropriate pain management: paracetamol (acetaminophen), oxycodone, nonacetylated salicylate (salsalate), propionic acid derivatives (ibuprofen or naproxen) for patients with eGFR >30 ml/min and no heart failure; add PPI as gastro-protectantif pain medication is given for >7 days
GI antispasmodics: atropine, dicyclomine, hyoscyamine, propantheline / Reflux disorders: esomeprazole
Painful abdominal cramps: morphine
Antidepressants
Depression / Amitriptyline, amoxapine, clomipramine, desipramine, imipramine, nortriptyline, paroxetine, trimipramine / SSRIs: citalopram, escitalopram, sertraline, fluoxetine (not paroxetine)
SNRIs: duloxetine, venlafaxine, bupropion
MAOI: mirtazapine
Insomnia / TCA: doxepin / Low dose TeCA, trazodone, mirtazapine
Non-benzodiazepine sedative-hypnotics: eszopiclone, zolpidem
Non-pharmacological therapy such as eliminate caffeine, reduce daytime napping
Neuropathic pain / TCA: amitriptyline, nortriptyline / Anticonvulsant: gabapentin or levetiracetam, capsaicin topical, pregabalin, lidocaine patch
SNRI: duloxetine
Antipsychotics
Acute care / Chlorpromazine, clozapine, olanzapine, perphenazine, quetiapine, thioridazine, trifluoperazine / Typical antipsychotic: haloperidol
Central anticholinergics
Movement disorder / Amantadine, benztropine, trihexyphenidyl, orphenadrine / Dopamine agonists: pramipexole, bromocriptine
Dopamine precursor: carbidopa and levodopa
COMT inhibitor: entacapone
Anti-emetics
Nausea and vomiting / Hydroxyzine, meclozine, promethazine, hyoscine / Serotonin 5-HT3 receptor antagonists: ondansetron
Pro-kinetic: metoclopramide
Analgesics
Opioids / Meperidine / Morphine, tramadol, oxycodone
5HT 5-hydroxytryptamine, COMT catechol O-methyltransferase, eGFR estimated glomerular filtration rate, GI gastrointestinal, MAOI monoamine oxidase inhibitor, PPI proton pump inhibitor, SNRIserotonin-norepinephrine reuptake inhibitor, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressant, TeCA tetracyclic antidepressant
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