Anticholinergic ADR — RACP Adult Medicine MCQ

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EasyClinical PharmacologyAnticholinergic ADRRACP Adult Medicine

A 60-year-old man with COPD is commenced on tiotropium (long-acting muscarinic antagonist). Which adverse effect is specific to anticholinergic bronchodilators that should be monitored?

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Correct answer: E — Urinary retention

Anticholinergic bronchodilators (tiotropium, glycopyrronium, umeclidinium) can cause urinary retention, particularly in elderly men with prostatic hypertrophy. Other anticholinergic effects include dry mouth (most common), constipation, and rarely acute angle-closure glaucoma (especially with nebulised delivery to the eyes). Patients should be asked about urinary symptoms before commencing therapy. Tachycardia, tremor, and hypokalaemia are associated with beta-2 agonists, not anticholinergics.

Reference: AMH – 2025 – Anticholinergic Bronchodilators; eTG – 2025 – Respiratory