What is a potential serious side effect of high-dose anticholinergic therapy?

High-dose anticholinergic therapy can lead to anticholinergic delirium or an acute confusional state, which is characterized by confusion, agitation, altered mental status, and sometimes hallucinations. This occurs because anticholinergic agents block the action of acetylcholine, a neurotransmitter that plays a critical role in many brain functions, including memory, attention, and cognitive processing. When these agents are used in excess, they can disrupt normal neurotransmission and lead to significant cognitive impairments.

This side effect is especially concerning because it can manifest quickly and severely, especially in vulnerable populations such as the elderly or those with pre-existing cognitive impairment. Recognizing and managing this type of delirium is crucial, as it can mimic other psychiatric or medical conditions, making diagnosis challenging. The risk of developing this state increases with both the dose and the duration of anticholinergic therapy, emphasizing the need for careful patient monitoring and dosage management.