Abstract
ABSTRACTObjective To develop a scale of anticholinergic activity drugs used in Brazil, to be applied in health care and pharmacoepidemiology research.Methods We performed a literature review on PubMed/MEDLINE® to identify previously published scales of anticholinergic drugs. This scale started with anticholinergic drugs, and those with known anticholinergic activity as per the 4th level, chemical-therapeutic subgroup, of the Anatomical Therapeutic Chemical classification. We also included drugs with high anticholinergic activity, as described in a list of potentially inappropriate medications for use in older adults, according to the 2015 American Geriatrics Society Beers Criteria. Drugs listed in at least two anticholinergic scales were added. Then we verified which drugs in the previous steps were marketed in Brazil. We assigned a score of 1, 2 and 3, based on their anticholinergic action.Results A total of 273 anticholinergic drugs were identified, of which 125 were included in the scale. We identified 45 (36.0%) drugs with a score of 3, 13 (10.4%) with a score of 2, and 67 (53.6%) with a score of 1. Drugs for the nervous and respiratory systems were the most frequent in the scale. Eight drugs were not present in previous scales.Conclusion The methodology used for development of the Brazilian anticholinergic activity scale is simple, systematized, reproducible and easy to update. The scale allows evaluating the impact of anticholinergic burden on health outcomes, and can potentially contribute to pharmacoepidemiology research, leading to more accurate measurements of anticholinergic activity.
Highlights
IntroductionScales have been developed to be used in clinical practice to measure the anticholinergic burden of drugs and, their potential to cause adverse effects.(1) Carnahan et al,(5) were among the first authors to propose a scale to rate drugs based on their anticholinergic potential
The anticholinergic burden refers to the cumulative effect of one or more drugs with anticholinergic activity.(2) Evidence suggests that a high anticholinergic burden is associated with greater morbidity and mortality, longer lengths of stay, higher institutionalization rates, as well as functional and cognitive decline.(2) these drugs should be cautiously prescribed to older adults, who are more vulnerable to anticholinergic effects due to the use of multiple drugs, higher blood-brain membrane permeability, and age-related pharmacokinetic changes.(3)
The development of implicit tools, in turn, can help guide the process of prescribing and simplifying drug schedules.(7) Measuring exposure to anticholinergics is a method used in clinical practice and healthcare research, Investigations help understand how the anticholinergic overload can impact health outcomes, they require appropriate methodologies and accurate measurements of exposure.(8) The anticholinergic activity scales currently available were developed and validated in the US, Europe and Australia.(1,3,8) they do not comprise all drugs with anticholinergic activity, and do not account for the drugs available in different countries.(1)
Summary
Scales have been developed to be used in clinical practice to measure the anticholinergic burden of drugs and, their potential to cause adverse effects.(1) Carnahan et al,(5) were among the first authors to propose a scale to rate drugs based on their anticholinergic potential. These scales are based on information from expert consensus reports, anticholinergic activity data, or a combination of both. The development of implicit tools, in turn, can help guide the process of prescribing and simplifying drug schedules.(7) Measuring exposure to anticholinergics is a method used in clinical practice and healthcare research, Investigations help understand how the anticholinergic overload can impact health outcomes, they require appropriate methodologies and accurate measurements of exposure.(8) The anticholinergic activity scales currently available were developed and validated in the US, Europe and Australia.(1,3,8) they do not comprise all drugs with anticholinergic activity, and do not account for the drugs available in different countries.(1)
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