Mental health

Role of anticholinergic medications in patients requiring long-term antipsychotic treatment for psychotic disorders

Question 6: In individuals with psychotic disorders (including schizophrenia) who require long term antipsychotic treatment, are anticholinergic medications more effective in preventing or reducing extrapyramidal side-effects and/or improving treatment adherence than placebo/treatment as usual?

Management of psychosis and bipolar disorders

  • Population: people with psychotic disorders, including schizophrenia
  • Interventions: anticholinergic medications in patients treated with antipsychotics
  • Comparison: placebo or antipsychotic treatment alone
  • Outcomes:
    • adverse effects of antipsychotic treatment
    • treatment adherence.


Anticholinergics should not be used routinely for preventing extrapyramidal side-effects in individuals with psychotic disorders (including schizophrenia) treated with antipsychotics.
Strength of recommendation: STRONG

Short-term use of anticholinergics may be considered only in individuals with significant extrapyramidal side-effects when dose reduction and switching strategies have proven ineffective, or when these side-effects are acute or severe.
Strength of recommendation: STANDARD

Anticholinergics should not be prescribed to pregnant women for the extrapyramidal side-effects of antipsychotic drugs except for acute short-term use.
Strength of recommendation: STRONG

Evidence profile