Overprescribing and polypharmacy have been identified as a risk to patients and the planet.1 Prescribing medications with a high anticholinergic burden carries significant risk for patients, particularly older people. The adverse outcomes that result from this also incur substantial carbon and planetary burdens which might be mitigated by deprescribing anticholinergic drugs where appropriate.
Polypharmacy (the concurrent use of multiple medication items by one individual)2 in older people are becoming increasingly common.34 One common aspect of polypharmacy is high anticholinergic burden.56 When one or more drugs with anticholinergic properties are prescribed, the risk of adverse events combines and accumulates. Examples of medications with an anticholinergic burden (ACB) are shown in table 1.
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Table 1 Commonly prescribed drugs with anticholinergic burden (ACB)
### Clinical implications
Drugs have different levels of anticholinergic effect. The extent of an individual’s ACB can be summarised through their ACB score, for which there are several validated ACB score calculators.7 The risks of anticholinergics increase with each additional point scored, with an increase in mortality associated with the number and ACB potency …