Develop a clear management plan collaboratively with the individual and/or carers if appropriate

Aim to develop mutually supportive and constructive discussions between individuals and prescribers when reviewing B-Z and their ongoing need. Where appropriate consider the fears and apprehensions associated with reducing/stopping B-Z and tailoring treatment to the individual’s needs. Where there may be health literacy issues, ensure that enough time is given for the consultation.

A stepped-care approach should be considered to tailor the most appropriate intervention to the individual’s needs such as self-help, non-pharmacological with or without pharmacological treatments.

Discuss realistic expectations and set review dates which can be coded for recall and follow-up.

Cumulative toxicity tool

Consider risk of cumulative toxicity in relation to co-prescribed medicines. See Cumulative toxicity tool below or in the Polypharmacy Guidance.³

Click on the image to open a larger version

Key: F - Falls and fractures; C – Constipation; UR - Urinary retention; CNS – CNS Depression; B – Bleeding; HF - Heart failure; Br – Bradycardia; CV - CV events; R – Respiratory; H – Hypoglycaemia; RI - Renal injury; Hypo – Hypokalaemia; Hype – Hyperkalaemia; SS - Serotonin syndrome; ACG – Angle Closure Angle Glaucoma

1. strong anticholinergics are: dimenhydrinate, scopolamine, dicyclomine, hyoscyamine, propantheline
2. strong anticholinergics are: tolterodine, oxybutynin, flavoxate
3. strong anticholinergics are: amitriptyline, desipramine, doxepine, imipramine, nortriptyline, trimipramine, protriptyline
4. strong anticholinergics are: promethazine
5. strong anticholinergics are: diphenhydramine, clemastine, chlorphenamine, hydroxyzine
6. Amiloride side effect frequency unknown