“Since the new tablets I’m confused, constipated and can’t wee properly”

A cluster of new/worsening confusion, constipation, dry mouth, blurred vision and urinary RETENTION coming on over weeks after starting an ANTIMUSCARINIC — on top of other anticholinergics (amitriptyline, a sedating antihistamine) — is ANTICHOLINERGIC TOXICITY / high anticholinergic burden: a reversible IATROGENIC mimic, not "ageing" or new dementia, with the rapid onset linked to a medication change as the giveaway. There is a cruel irony to spot: the oxybutynin given FOR urinary urgency has caused retention. The task is a full medication review INCLUDING OTC items, identifying the stacked anticholinergics and DEPRESCRIBING them (stop oxybutynin; review and taper amitriptyline, which NICE NG59 does not recommend for low back pain; stop the antihistamine; safer alternatives for the urgency, back pain and sleep), assessing the urinary retention (acute retention may need urgent action), and rechecking cognition once off the drugs — avoiding the prescribing cascade of adding more drugs or labelling dementia. The examinable hidden agenda is the family’s unspoken dementia terror; deliver the hopeful, evidence-based reframe (likely reversible, not dementia), handle the OTC disclosure non-judgementally, and follow up to confirm improvement — reversing iatrogenic harm rather than compounding it.