Polypharmacy Guidance: appropriate prescribing, making medicines safe, effective and sustainable 2025 - 2028
5. Anticholinergic burden
| Our recommendations, based on three GLs, two of high quality, and the third of low quality, and eight SRs, five of high quality, two acceptable, and one of low quality | Strength of recommendation |
|---|---|
| 1. Prescribers should practice caution when prescribing medicines with ACB, prescribing only the minimum needed, especially for older adults, people with frailty, or people with complex multimorbidities. This is due to the association between ACB and mortality and increased risk of cognitive impairment, dementia, and delirium. | Strong recommendation |
| 2. A person-centred approach should be taken when assessing the impact of harm of anticholinergic medication and the benefits when discontinuing anticholinergic drugs. | Strong recommendation |
| 3. Prescribers should carefully consider if the benefits of prescribing a drug with ACB are greater than the risks | Conditional recommendation |
| 4. Prescribers might want to consider minimising prescribing of drugs with ACB as part of assessment of falls tisk for those people with the highest level of ACB (e.g. ACBS⩾4), which might be indicative of the greatest risk of falls. | Conditional recommendation |
| 5. There is some evidence that a pharmacist undertaking patient medication review and then feeding back to the prescriber can lead to a significant reduction in ACB. | Conditional recommendation |
| 6. In patients with dementia, perform a medication review to minimise medicines that may adversely affect cognitive function. Avoid prescribing of anticholinergics with acetylcholinesterase inhibitors. As part of the review, a MMSE may be helpful to assess impact of medication. | Strong recommendation |