Could Anticholinergics Be Making Your Fibromyalgia Worse?

Medications are a common part of managing fibromyalgia. Most fibro patients find that medications don’t offer complete relief though they can make things at least a little better. But the downside of most medications is that they each come with their own set of side effects and some even carry risks.

What you might not know is that many medications prescribed to fibro patients are part of a potentially dangerous class of drugs called anticholinergics. When you take these drugs, particularly if you take multiple different ones, they can have a cumulative effect that makes you feel worse. Read on to find out what kind of drugs are anticholinergics and how you can recognize problems.

What Does Anticholinergic Mean?

Anticholinergics are a type of medication that blocks the hormones that control nerve impulses. Some of the more common uses for anticholinergics are to stop mucus, control muscle movements, and to slow down digestive disorders. People without chronic health problems might use anticholinergics to provide allergy relief, manage diarrhea, or treat overactive bladder.

What Kind of Drugs are in the Anticholinergic Category?

You might be surprised by the number of medications that are in the category called anticholinergics. Each medicine in that category is ranked with a score from 1 to 3, measuring the amount of impact the medication can have on cognitive effects. Some of the medications that are considered anticholinergics include the following:

  • Allergy medicine, including Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine), Claritin (loratadine) and Zyrtec (cetirizine). Note that these may be found in multi-drug combinations for sleep, like Tylenol PM.
  • Antidepressants, which may be prescribed off-label to fibro patients to help sleep or chronic pain. Some drugs in this category include Elavil (amitriptyline), Paxil (paroxetine), and Vistaril (hydroxyzine).
  • Anxiety relieving medications, such as Xanax (alprazolam)
  • Anti-diarrheal medicines, such as Imodium (loperamide)
  • Anti-nausea medicines, such as Phenergan (promethazine) and Antivert (meclizine)
  • Codeine and medications that use codeine as a compound. Synthetic versions of codeine like Norco or Vicodin do not seem to have the same anticholinergic effects, although they can still have side effects similar to anticholinergics.
  • Muscle relaxers, such as baclofen, Flexeril (cyclobenzaprine), and Soma (carisoprodol.)
  • Overactive bladder medicines, including Detrol (tolterodine)
  • Anti-psychotic medications such as Zyprexa (olanzaprine) which are often prescribed to help with sleep or in conjunction with antidepressants to help with treatment-resistant depression.

What are the Side Effects of Anticholinergic Medications

In recent years, researchers have issued warnings about the use of anticholinergic medications, particularly in the elderly. Studies suggested that anticholinergic medications could cause problems with dementia and memory loss in seniors. Many doctors will say that anticholinergic medications should not cause any problems, especially in younger and healthier individuals.

However, the side effects of anticholinergic medications can still have negative effects when people of any age take them. Medications in the anticholinergic category are commonly prescribed to people with fibromyalgia, often off-label. The drugs are prescribed to help with pain, anxiety, depression, and headaches. The most common side effects experienced when taking anticholinergics include the following:

  • Memory loss
  • Confusion
  • Drowsiness
  • Delirium
  • Sedation
  • Hallucinations
  • Blurred visions
  • Dry mouth
  • Difficulty with urination
  • Constipation

These medications are ranked by the strength of their anticholinergic effects. Older tricyclic antidepressants, for example, have a strong anticholinergic effect. Even though selective serotonin reuptake inhibitor (SSRI) antidepressants have milder anticholinergic effects, they do still have this effect.

The more of these medications that you take in combination with each other, the more likely you are to experience side effects. They tend to compound one another for a cumulative effect.

How Do I Know if Anticholinergics are Making Me Worse?

Ironically, the same medications you’re taking to make you feel better could actually be making you feel worse. Muscle relaxers often have a rebound effect: they relieve your muscle pain at first but cause more intense pain as they start to wear off.

Although confusion and memory loss are concerns in elderly patients, there’s some evidence that younger patients can have the same effects, as well. Since that your medications could be affecting you include the following:

  • If you feel like you’re frequently confused
  • if you’ve noticed it’s more difficult to concentrate and focus
  • if you often feel disoriented

Talk to your doctor if you think your medications are causing these problems. Many doctors may not initially think these medications can cause problems, particularly in younger patients, although some younger people anecdotally report these experiences as well. Keep a log of your symptoms to share with your doctor, who can help you decide if your symptoms are medication side effects or due to other causes.

Have a discussion with your doctor if you want to see if you might feel better off of the medications. Make sure you look into how to safely discontinue them before quitting them cold turkey. Medicines such as benzodiazepines (like Xanax or Valium) can cause seizures if discontinued too quickly. Medications can help you but you should occasionally check to make sure they’re still having benefits.