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Farmacia Hospitalaria

versión On-line ISSN 2171-8695versión impresa ISSN 1130-6343

Farm Hosp. vol.41 no.5 Toledo sep./oct. 2017 

Letters to the Editor

Development of the Anticholinergic Burden Calculator Web Tool

Desarrollo de la herramienta web Anticholinergic Burden Calculator

Ángela Villalba-Moreno1  , Eva Rocío Alfaro-Lara2  , Susana Sánchez-Fidalgo3  , María Dolores Nieto-Martín4  , Bernardo Santos-Ramos1 

1Pharmacy Service, University Hospital Virgen del Rocío, Seville. Spain.

2Andalusian Agency for Health Technology Assessment, Seville. Spain.

3Pharmacy Service, University Hospital Valme, Seville. Spain.

4Internal Medicine Service. University Hospital Virgen del Rocío, Seville. Spain.

Sra. Directora:

The anticholinergic burden is defined as the cumulative effect of concomitantly taking multiple drugs with anticholinergic properties. It estimates the risk of suffering anticholinergic adverse effects. Anticholinergic scales are lists that rank the anticholinergic potential of drugs into categories. A patient’s burden may be calculated from the sum of the score of each drug included in the scale. This assessment provides clinicians the opportunity to reconsider the pharmacotherapy in order to optimize treatment1.

Our research group has designed and developed a tool which calculates the anticholinergic burden based on 10 anticholinergic scales which have been firstly identified in a review2 with the aim to be used in clinical setting. The tool was named Anticholinergic Burden Calculator (ABC). It is a web portal software program ( (An app for smart phones is now in progress).

Anticholinergic risk scores are defined into three groups, low, medium and high, according to risk categorization made by the authors of each scale. The user can view a report that contains three tables and one graphic that describe the results (Fig. 1). Drug Burden Index scale is separately described because it is the only one based on a simple mathematical formula that takes into account the prescribed dose and the minimum effective dose3.

The Anticholinergic Burden Calculator (ABC) has been validated for accuracy. Medication data including drug name and dose were collected from 35 patients with multimorbidity included in the IMPACTO project involving a total of 310 drugs4. The anticholinergic burden was calculated twice, manually and with Anticholinergic Burden Calculator (ABC). The results showed a 100% agreement.

The hand made anticholinergic burden calculation may be a tedious process. The tool facilitates the calculation of the total burden using 10 scales in a single step. Moreover, the professionals obtain very valuable information about treatment identifying which patients are at risk. On the other hand, they know drugs associated with increased risk and their contribution to the total load (the higher score, the greater risk). Thus, it facilitates decision-making on patient pharmacotherapy, reconsidering the treatment to reduce the load, for example, by deprescription, decreasing doses or substituting one drug for another without anticholinergic properties.

Our research group is currently working to improve the functionality of the web. Specific recommendations to help clinicians to make better decisions are in progress (Figura 1).

Figure 1 Tables and graphic according to risk score. 


Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharm. 2013;69:1485-96. [ Links ]

Villalba-Moreno AM, Alfaro-Lara ER, Pérez-Guerrero C, Nieto-Martín MD, Santos-Ramos B. Systematic review on the use of anticholinergic scales in poly pathological patients. Arch Gerontol Geriat. 2016;62:1-8. [ Links ]

Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG. A Drug Burden Index to define the functional burden older people. Arch Intern Med. 2007;167:781-7. [ Links ]

Implantación del Plan de Asistencia Continuada a Pacientes Patológicos. Impacto sobre la Evolución Natural de la Enfermedad, el Deterioro Funcional y la Calidad de Vida Proyecto IMPACTO (Monografía en Internet). (Consultado 20/03/2017). Disponible en: ]

Funding This study has been supported by grants from Consejería de Salud, Junta de Andalucía (PI-0195-2016).

Received: March 24, 2017; Accepted: April 28, 2017

Autor para correspondencia. Correo electrónico: (Susana Sánchez-Fidalgo)

Conflicts of interests

The authors concerned declare that they do not have any conflicts of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License