4CPS-128 Anticholinergic load: a better score for a gold prescription?

<h3>Background and Importance</h3> Many drugs have anticholinergic effects. These effects may be central and/or peripheral and may have major consequences in elderly people. <h3>Aim and Objectives</h3> The aim of this study was to analyse the anticholinergic load (AL) of prescriptions in this population and to study the impact of pharmaceutical intervention (PI) on these prescriptions. <h3>Material and Methods</h3> This work was carried out in collaboration with three medical unit in our institution. All patients aged at least 75 and hospitalised from July 2024 were included. For each patient, the AL was calculated at entry using the « Prescription anticholinergic load calculator »*. Each molecule has a score ranging from 0 to 3 to characterise its anticholinergic effects. The sum of the scores for each drug gives the patient‘s overall AL. If this was considered « high » (presence of at least one compound with a score ≥ 2 and/or if the overall AL was above the theoretical thresholds (≥ 5 at peripheral level and ≥ 4 at central level)), a PI was carried out to inform the prescriber and to jointly consider a strategy to be followed. The patient‘s AL was again calculated on discharge from hospital. <h3>Results</h3> Of the 60 patients included in the study: 23 (38%) had a high AL at admission requiring a PI. The completion of 23 PI led to a reduction in the discharge score for 13 patients (56%). It remained the same for 8 patients (35%) and increased for 2 (9%). Of these patients, 15 had a drug classified as « 3 » in their initial treatment, compared with 9 at discharge, a reduction of 40%. For 3 patients, a combination of 2 molecules classified as « 3 » was observed at entry, compared with 0 at discharge. Finally, 13 patients had a AL above the theoretical thresholds, compared with 7 at discharge (down 46%). The majority of PIs were switches for drugs with a lower score, or discontinuation of treatment with no indication. <h3>Conclusion and Relevance</h3> In the population studied, AL was inappropriate in almost 40% of cases. The results show the beneficial impact of pharmaceutical interventions on the adaptation of anticholinergic drugs. <h3>References and/or Acknowledgements</h3> https://www.omedit-paysdelaloire.fr/wp-content/uploads/2021/10/20220510_Calculateur-echelles-CIA-ACB-v1.xlsx <h3>Conflict of Interest</h3> No conflict of interest