The Problem:
Commonly used medications have anticholinergic effects that inhibit acetylcholine receptors. When patients are taking multiple anticholinergic medications concurrently, the additive effects can be cumulative - hence, the term “anticholinergic burden.”
Why It Matters:
Excessive anticholinergic burden is linked to:
An increased risk of falls (2 times higher)
Cognitive dysfunction and delirium
Higher mortality rates in older patients
Exacerbation of dementia symptoms
Common Offenders (Anticholinergic Cognitive Burden Scale):
Score 3 (High): Oxybutynin, amitriptyline, chlorpheniramine, diphenhydramine, doxepin
Score 2 (Moderate): Carbamazepine, cyclobenzaprine, loperamide, nortriptyline, paroxetine
Score 1 (Low): Alprazolam, cimetidine, digoxin, furosemide, warfarin
The Pharmacist’s Responsibility:
When evaluating patients’ medication profiles, calculate the patient’s total anticholinergic burden score. A cumulative score of ≥3 is associated with a substantial increase in adverse reactions.
Alternative Medications to Consider:
Oxybutynin → Mirabegron (for overactive bladder)
Diphenhydramine → Loratadine/cetirizine (for allergies)
Amitriptyline → Duloxetine or gabapentin (for neuropathic pain)
Clinical Pearl: Older patients taking multiple
MBH/PS