The anticholinergic burden: from research to practice

Drugs with anticholinergic effects are known to cause adverse effects such as dry mouth, constipation and urinary retention. In older people drugs with anticholinergic effects may contribute to cognitive decline and a loss of functional capacity. Many drugs that are not in the anticholinergic drug class also have anticholinergic effects. They include antidepressants, antipsychotics and antihistamines. Taking multiple drugs with anticholinergic effects creates an anticholinergic burden. It is important that clinicians identify which patients are at risk. There are several tools to assess the anticholinergic burden. Clinicians can use these tools to make a pharmacological risk assessment when reviewing a patient’s medicines. This can assist decisions about continuing or stopping drugs with anticholinergic effects. Deprescribing drugs with anticholinergic effects has several potential benefits in older people. In addition to reversing adverse effects, deprescribing may prevent problems such as falls.