Association between anticholinergic burden and anticholinergic adverse outcomes in the elderly: Pharmacological basis of their predictive value for adverse outcomes. (January 2021)

• Record Type: Journal Article
• Authors: Lavrador, Marta; Castel-Branco, M. Margarida; Cabral, Ana C.; Veríssimo, Manuel T.; Figueiredo, Isabel V.; Fernandez-Llimos, Fernando
• Is Part Of: Pharmacological research. Volume 163(2021)
• Publication Date: 2021-01
• Subjects: AAS Anticholinergic Activity Scale -- ABC Anticholinergic Burden Classification -- ABS Anticholinergic Burden Score -- ACB Anticholinergic Cognitive Burden Scale -- ACh Acetylcholine -- ACL Anticholinergic Loading Scale -- AD Alzheimer's disease -- ADS Anticholinergic Drug Scale -- AEC Anticholinergic effect on cognition -- ARS Anticholinergic Risk Scale -- BBB Blood Brain Barrier -- CNS Central Nervous System -- CrAS Clinician-rated Anticholinergic Score -- DBI Drug Burden Index -- DBI-WHO Drug Burden Index – World Health Organization -- DDD Defined Daily Dose -- (G)MainD The (Geriatric) Maintenance Dose -- (G)MaxEV The (Geriatric) Maximal Effective Dose -- (G)MinEV The (Geriatric) Minimal Effective Dose -- 3H-QNB tritiated radioligand quinuclidinyl benzilate -- IADL Instrumental activities of daily living -- KABS Korean Anticholinergic Burden Scale -- MARANTE Muscarinic Acetylcholinergic Receptor ANTagonist Exposure -- MMSE Mini-Mental State Examination -- SAA Serum Anticholinergic Activity -- SmPC Summary of Products Characteristics -- SPPB Short Physical Performance Battery; Atropine -- Trospium chloride -- Oxybutynin -- Amitriptyline -- Darifenacin -- Citalopram -- Digoxin -- Diazepam -- Furosemide -- Clozapine; Cholinergic antagonists -- Anticholinergic effects -- Aged -- Risk assessment -- Reproducibility of results; Pharmacology -- Periodicals; Pharmacology -- Periodicals; Research -- Periodicals; Médicaments -- Recherche -- Périodiques; Pharmacologie -- Périodiques; 615.105
• DOI: 10.1016/j.phrs.2020.105306
• Languages: English
• ISSNs: 1043-6618

Abstract

Graphical abstract: Abstract: The use of anticholinergic drugs and other drugs with anticholinergic activity is highly prevalent in older people. Cumulative anticholinergic effects, known as anticholinergic burden, are associated with important peripheral and central adverse effects and outcomes. Several methods have been developed to quantify anticholinergic burden and to estimate the risk of adverse anticholinergic effects. Serum anticholinergic activity (SAA) and anticholinergic burden scoring systems are the most commonly used methods to predict the occurrence of important negative outcomes. These tools could guide clinicians in making more rational prescriptions to enhance patient safety, especially in older people. However, the literature has reported conflicting results about the predictive ability of these tools. The majority of these instruments ignore relevant pharmacologic aspects such as the doses used, differential muscarinic receptor subtype affinities, and blood-brain barrier permeability. To increase the clinical relevance of these tools, mechanistic and clinical pharmacology should collaborate. This narrative review describes the rational and pharmacological basis of anticholinergic burden tools and provides insight about their predictive value for adverse outcomes.