Do you routinely prescribe an anticholinergic agent for EPS prophylaxis when starting or continuing antipsychotics or do you prefer to use it only as needed (PRN) if/when symptoms develop?  

In the setting of starting long-term treatment with antipsychotics, anticholinergics should not be started automatically for prophylaxis of EPS. Anticholinergics have numerous significant side effects and often are continued indefinitely without ever clarifying if patients actually have EPS.Antichol...

EPS from an antipsychotic occurs early in the course of treatment or with dose escalation. EPS is usually transient so anticholinergics should not be used long-term. Also, anticholinergics have a lousy side effect profile. Ideally, we treat patients with drugs that don't have side effects that requi...

I used to do this routinely and was trained to do this (years ago!). However, I now do two things: Prescribe PRN only with very clear instructions on when and how to use it (more than 50% of patients do not end up using it). It has side effects itself. I taper those who have been on it with NO ...

In general, it's best to treat EPS symptoms only as needed. I strongly suggest using amantadine first, and an anticholinergic if needed, because of the side effects. I explain the rationale to patients and describe the possible EPS syndromes. If I'm treating a psychotic patient, who's rather paranoi...

I agree with the general notion of watch and wait. Amantadine seems to be an excellent choice if treatment is needed. In the old days, we used anticholinergics most, even with dry mouth, blurry vision, and constipation which we worked around as noted. When anticholinergic effects on memory became an...

If you search the literature for long-term consequences of anticholinergic medications, you will find several articles addressing the very real issue of cognitive impairment resulting from prolonged exposure to these medications. What is most concerning is the reality that, in many patients, cogniti...