In men with lower urinary symptoms/BPH, which drug class is strongly anticholinergic and should be avoided?

• A. Beta blockers
• B. PDE-5 inhibitors
• C. Non-steroidal anti-inflammatory drugs
• D. Strongly anticholinergic drugs

Answer: (D)

Strongly anticholinergic drugs should be avoided in men with lower urinary symptoms/BPH because they block acetylcholine at the detrusor muscle of the bladder, reducing its ability to contract. In the setting of BPH, where there is already some obstruction and potential incomplete bladder emptying, further reducing detrusor contractility can worsen urinary retention and increase post-void residual. In older adults, these drugs contribute to delirium and other cognitive problems, which is exactly what the Beers Criteria warns against. Other listed drug classes do not carry the same strong anticholinergic burden, so they are not implicated in this specific caution.