Anticholinergic load is a common, reversible contributor to delirium, falls, constipation and urinary retention in older inpatients, and it accumulates from drugs prescribed for unrelated problems.
On admission, scan the list for the usual culprits: first-generation antihistamines such as chlorphenamine and promethazine, tricyclic antidepressants, bladder antimuscarinics such as oxybutynin, paroxetine, and some antipsychotics. Many are started for sleep, itch or urgency and never reviewed. Tools such as the Anticholinergic Cognitive Burden scale score each drug from 1 to 3; a total of 3 or more is linked to worse cognition and outcomes.
Where a drug can be stopped or switched, do it during the admission and say so in the discharge letter, so it is not restarted.
- Scan every older patient's list for antihistamines, tricyclics, bladder antimuscarinics and paroxetine
- Treat a total anticholinergic score of 3 or more as a reason to deprescribe
- Prefer non-sedating alternatives for sleep, itch and urgency
- Record any stopped drug clearly in the discharge summary
Why it matters
The inpatient stay is often the only time anyone reviews the whole medication list.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free