Department of Pharmacy, University Hospital, LMU Munich, Munich, Germany.
Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany.
BMC Geriatr. 2018 Oct 11;18(1):239. doi: 10.1186/s12877-018-0929-6.
Anticholinergic drugs put elderly patients at a higher risk for falls, cognitive decline, and delirium as well as peripheral adverse reactions like dry mouth or constipation. Prescribers are often unaware of the drug-based anticholinergic burden (ACB) of their patients. This study aimed to develop an anticholinergic burden score for drugs licensed in Germany to be used by clinicians at prescribing level.
A systematic literature search in pubmed assessed previously published ACB tools. Quantitative grading scores were extracted, reduced to drugs available in Germany, and reevaluated by expert discussion. Drugs were scored as having no, weak, moderate, or strong anticholinergic effects. Further drugs were identified in clinical routine and included as well.
The literature search identified 692 different drugs, with 548 drugs available in Germany. After exclusion of drugs due to no systemic effect or scoring of drug combinations (n = 67) and evaluation of 26 additional identified drugs in clinical routine, 504 drugs were scored. Of those, 356 drugs were categorised as having no, 104 drugs were scored as weak, 18 as moderate and 29 as having strong anticholinergic effects.
The newly created ACB score for drugs authorized in Germany can be used in daily clinical practice to reduce potentially inappropriate medications for elderly patients. Further clinical studies investigating its effect on reducing anticholinergic side effects are necessary for validation.
抗胆碱能药物会使老年患者跌倒、认知能力下降和谵妄的风险增加，还会引起口干或便秘等外周不良反应。医生通常不知道患者药物相关的抗胆碱能负担（ACB）。本研究旨在开发一种适用于临床医生开处方级别的德国许可药物的抗胆碱能负担评分。
在 pubmed 中进行系统文献检索，评估先前发表的 ACB 工具。提取定量分级评分，将其简化为德国可用的药物，并通过专家讨论重新评估。药物被评为无、弱、中或强抗胆碱能作用。在临床常规中还确定了其他药物并将其纳入。
文献检索确定了 692 种不同的药物，其中 548 种在德国可用。由于无系统作用或药物组合评分（n=67）排除药物后，以及对临床常规中另外 26 种已识别药物进行评估后，对 504 种药物进行了评分。其中，356 种药物被归类为无，104 种药物被评为弱，18 种被评为中，29 种被评为强抗胆碱能作用。
新创建的德国授权药物的 ACB 评分可用于日常临床实践，以减少老年患者潜在的不适当药物。需要进一步的临床研究来验证其减少抗胆碱能副作用的效果。
