European Journal of Clinical Pharmacology

, Volume 69, Issue 7, pp 1485–1496 | Cite as

Systematic review of anticholinergic risk scales in older adults

  • Carlos E. Durán
  • Majda Azermai
  • Robert H. Vander SticheleEmail author
Pharmacoepidemiology and Prescription



Anticholinergic drugs are often involved in explicit criteria for inappropriate prescribing in older adults. Several scales were developed for screening of anticholinergic drugs and estimation of the anticholinergic burden. However, variation exists in scale development, in the selection of anticholinergic drugs, and the evaluation of their anticholinergic load. This study aims to systematically review existing anticholinergic risk scales, and to develop a uniform list of anticholinergic drugs differentiating for anticholinergic potency.


We performed a systematic search in MEDLINE. Studies were included if provided (1) a finite list of anticholinergic drugs; (2) a grading score of anticholinergic potency and, (3) a validation in a clinical or experimental setting. We listed anticholinergic drugs for which there was agreement in the different scales. In case of discrepancies between scores we used a reputed reference source (Martindale: The Complete Drug Reference®) to take a final decision about the anticholinergic activity of the drug.


We included seven risk scales, and evaluated 225 different drugs. Hundred drugs were listed as having clinically relevant anticholinergic properties (47 high potency and 53 low potency), to be included in screening software for anticholinergic burden.


Considerable variation exists among anticholinergic risk scales, in terms of selection of specific drugs, as well as of grading of anticholinergic potency. Our selection of 100 drugs with clinically relevant anticholinergic properties needs to be supplemented with validated information on dosing and route of administration for a full estimation of the anticholinergic burden in poly-medicated older adults.


Anticholinergic drugs Risk scale Aged Anticholinergic activity 



We thank Thierry Christiaens and Veronika Wirtz for assistance in developing the methodology for this project.

This study was funded by a grant from the Flemish Interuniversity Council, through the University Development Cooperation (VLIR-UOS), Belgium. The funding agency was in no way implicated in the study design, data collection, analysis and interpretation, nor was there any involvement in the decision to submit the paper for publication.

Conflict of interest

None to declare


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Carlos E. Durán
    • 1
  • Majda Azermai
    • 2
  • Robert H. Vander Stichele
    • 2
    Email author
  1. 1.Centro de BiomedicinaUniversidad Central del EcuadorQuitoEcuador
  2. 2.Heymans Institute of PharmacologyGhent UniversityGhentBelgium

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