Etusivulle

Identification of anticholinergics

  • Serum anticholinergic activity (SAA)
  • Considered the “golden standard”, however, it measures both anticholinergic drugs, their metabolites, and also endogenous substances5
  • In practice, the lists of anticholinergic drugs better identify the risks of adverse events associated with the use of these drugs6
  • Different anticholinergic lists7-13 evaluate the effect of different anticholinergic drugs in a different way
  • An overview article14 has been used as the source for the following list. The list in it was made based on a previously published review article37, meaning the views of several anticholinergic lists have been taken into account

 

Previous References

5. Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56:1333-41.

6. Lampela P, Lavikainen P, Garcia-Horsman JA, Bell JS, Huupponen R, Hartikainen S. Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging 2013;30:321-30.

7. Ancelin ML, Artero S, Portet F, Dupuy AM, Touchon J, Ritchie K. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ 2006;332:455-9.

8. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 2006;46:1481-6.

9. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, Harris TB, Hanlon JT, Rubin SM, Shorr RI, Bauer DC, Abernethy DR, A Drug Burden Index to Define the Functional Burden of Medications in Older People. Arch Intern Med 2007;167:781-787.

10. Boustani M, Cambell N, Munger S et al. Impact of anticholinrgics on the aging brain: A review and practical application. Aging Health 2008;4:311-20.

11. Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med 2008;168:508-513.

12. Svenska Socialstyrelsen. Indikatorer för god läkemedelterapi hos äldre. (The National Board of Health and Welfare of Sweden; in Swedish). Available at http://www.socialstyrelsen.se/publikationer2010/2010-6-29

13. Sittironnarit G, Ames D, Bush AI, Faux N, Flicker L, Foster J, Hilmer S, Lautenschlager NT, Maruff P, Masters CL, Martins RN, Rowe C, Szoeke C, Ellis KA; AIBL research group. Effects of anticholinergic drugs on cognitive function in older Australians: results from the AIBL study. Dement Geriatr Cogn Disord 2011;31:173-8.

14. Nishtala PS, Salahudeen MS, Hilmer SN. Anticholinergics: theoretical and clinical overview. Expert Opin Drug Saf 2016;15(6):753-68.

37. Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 2015;15:31.

Examples of lists

  • Anticholinergic Burden Classification (ABC)7
  • Anticholinergic Drug Scale (ADS)8
  • Drug Burden Index (DBI)9
  • Anticholinergic Cognitive Burden Scale (ACB)10
  • Anticholinergic Risk Scale (ARS)11
  • Svenska Socialstyrelsen’s list12
  • AntiCholinergic Load (ACL)13