Which is a common management step for anticholinergic effects caused by antipsychotics?

• A. Switch to a different antipsychotic
• B. Increase the dose
• C. Lower the dose of the antipsychotic
• D. Add a benzodiazepine

Answer: (C)

Anticholinergic effects from antipsychotics come from blocking muscarinic receptors, and this blockade tends to increase with higher drug exposure. The most common way to lessen these effects is to reduce the antipsychotic dose, which lowers receptor occupancy at muscarinic sites and reduces symptoms such as dry mouth, constipation, blurred vision, urinary retention, and cognitive slowed thinking. If reducing the dose risks the effectiveness of treatment, clinicians may consider switching to an agent with a lower antimuscarinic burden or optimizing the regimen while maintaining the lowest effective dose. Adding a benzodiazepine doesn’t address the anticholinergic side effects and can add sedation or other risks.