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Amitriptyline anticholinergic burden — GPhC CRA MCQ

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HardCNS TherapeuticsAmitriptyline anticholinergic burdenGPhC CRA

A 76-year-old woman takes amitriptyline 25mg at night for neuropathic pain. Her daughter reports new confusion, dry mouth and two falls since the dose was increased. The patient also has glaucoma and constipation. What is the most appropriate alternative?

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Correct answer: D — Discuss switching to a less anticholinergic neuropathic pain option

Amitriptyline has anticholinergic and sedative effects that can contribute to confusion, constipation, glaucoma problems and falls in older people. The timing after dose increase supports a medicine-related cause. The prescriber should review neuropathic pain treatment and falls risk.

Reference: BNF; NICE CKS