Anticholinergic effects accumulate across drugs that are not thought of as anticholinergic — oxybutynin and tolterodine, amitriptyline and paroxetine, chlorpheniramine and promethazine, some antipsychotics, and drugs for dizziness and gut spasm.
In older adults the combined burden is linked to confusion, falls, constipation and urinary retention. A simple scale such as the Anticholinergic Cognitive Burden score makes the total visible and highlights the easiest drug to stop.
- Score anticholinergic burden using a published scale during medication review
- Target a total score of 3 or more for deprescribing
- Replace first-generation antihistamines and tricyclics with safer alternatives
- Check for over-the-counter cold, sleep and travel sickness products
Why it matters
Anticholinergic load is a common, reversible contributor to confusion and falls in older people.
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