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Anticholinergic cognitive burden scale

NOV 2009

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This scale was developed Dr. Malaz Boustani, a researcher at the Regenstrief Institute and the Indiana University Center for Aging Research, and her colleagues.

A drug was given a score of 1 if it had possible anticholinergic effects based on lab tests but no evidence of clinically relevant cognitive effects A drug was given a score of 2 or 3 if it had established and clinically relevant anticholinergic effects. Drugs not listed have a score of 0.

The idea is to add up the scores of the drugs a person is taking. If the sum of the scores is 3 or more, then medications with lower anticholinergic cognitive burden scores might be considered to lower the overall anticholinergic cognitive burden.

The drugs are listed in alphabetical order with the generic name listed first, followed by notable brand names.

Score 1

Score 2

Score 3

alprazolam (Xanax)

amantadine (Symadine)

amitriptyline (Elavil)

atenolol (Tenormin)

belladone alkaloids

amoxapine (Asendin)

brompheniramine maleate (Veltane)

carbamazepine (Carbatrol, Teril)

benztropine (Cogentin)

bupropion hydrochloride (Wellbutrin, Zyban)

cyclobenzaprine (Amrix, Flexeril)

carbinoxamine (Clistin)

captopril (Capoten)

cyproheptadine (Periactin)

chlorpheniramine (an ingredient in many cough and cold medicines)

chlorthalidone (Thalitone)

loxapine (Loxitane)

clemastine (Tavist)

cimetidine hydrochloride (Tagamet)

meperidine (Demerol)

clomipramine (Anafranil)

clorazepate (Tranxene)

methotrimeprazine (Levoprome, Nozinan)

clozapine (Clozaril)

codeine

molindone (Moban)

darifenacin (Enablex)

colchicine (Colcrys)

oxcarbazepine (Trileptal)

desipramine (Norpramine, Pertofrane)

diazepam (Valium)

pimozide (Orap)

dicyclomine (Bentyl)

digoxin (Lanoxin)

  

dimenhydrinate

dipyridamole (Persantine)

  

diphenhydramine (an ingredient in cough and cold medicines)

disopyramide phosphate (Norpace)

  

doxepin (Sinequan, Zonalon)

fentanyl

  

flavoxate (Urispas)

isosorbide (Ismotic)

  

hydroxyzine (Atarax, Vistaril)

loperamide (Imodium)

  

imipramine (Janimine, Tofranil)

metoprolol (Lopressor, Toprol-X)

  

meclizine (Antivert)

morphine

  

nortriptyline (Pamelor)

nifedipine (Adalat, Procardia)

  

olanzapine (Zyprexa)

prednisone

  

orphenadrine (Disipal, Norflex)

quinidine (Duraquin, Quinora)

  

oxybutynin (Ditropan)

risperidone (Risperdal)

  

paroxetine (Paxil)

theophylline (many brands)

  

perphenazine (Trilafon)

trazodone (Desyrel, Trialodine)

  

procyclidine (Kemadrin)

triamterene (Dyrenium)

  

promethazine (Phenergan, Zipan)
   

quetiapine (Seroquel)
   

Scopolamine
   

thioridazine (Mellaril)
   

tolterodine (Detrol)
   

trifluoperazine (Stelazine)
   

trihexyphenidyl (Artane, Tremin)
   

Trimipramine (Surmontil)