The challenges of deprescribing and minimizing


INDIANAPOLIS – Drugs with anticholinergic properties have been consistently associated with a wide range of adverse effects in older adults, including cognitive impairment, but these drugs continue to be commonly prescribed for depression, urinary incontinence, down syndrome irritable bowel and Parkinson’s disease.

In an editorial published in the peer-reviewed journal Frontiers in Pharmacology, co-authors Noll Campbell, PharmD, MS, and Malaz Boustani, MD, MPH, from the Regenstrief Institute (USA) and colleagues Roy Soiza, MBChB, from the University of Aberdeen (UK) and Arduino Mangoni, MD , PhD, from Flinders University (Australia) highlight the complexity of better understanding how to safely deprescribe anticholinergic drugs given the risks they carry and the significant difficulty encountered in all cultures in reducing their use.

Anticholinergics affect the brain by blocking acetylcholine, a nervous system neurotransmitter that influences memory, alertness and planning abilities. These drugs are used by about one in four seniors each year in the United States.

The editorial’s authors find that physicians’ and pharmacists’ awareness of the dangers of anticholinergic therapy is growing, propelling research into these drugs and opportunities for deprescribing. However, there is currently no easy or reliable way for patients to know if the anticholinergics they use today will cause adverse effects in the future. There are also no high quality studies on how to identify current users who should stop these drugs and what will happen if they do.

“While we at the Regenstrief Institute and other researchers around the world have identified a strong and consistent link between anticholinergic drugs and cognitive impairment from observational studies, randomized clinical trials represent the only method to definitively establish a causal relationship between these frequently used drugs and various dementias,” said editorial co-author Dr. Campbell, an expert in deprescribing. “We are almost halfway through a large randomized, controlled trial on multi-year anticholinergic deprescribing that will help us understand whether these drugs are causally related to cognitive impairment as well as other outcomes associated with deprescribing.”

He adds that “what we are learning about how to make changes at the provider and patient level for anticholinergics may well apply to other high-risk drug classes like benzodiazepines and opioids.”

“Physicians should review all prescription and over-the-counter medications with older patients to determine exposure to anticholinergics and discuss options that are less harmful to the aging brain,” said Dr. Boustani, geriatrician and co- author of the editorial. Dr. Boustani is a pioneer in research and clinical practice in the care of the aging brain. He and his colleagues at the Regenstrief Institute developed the Anticholinergic Load Scale.

“Editorial: Deprescribing and reducing the use of anticholinergic drugs” is published in the open access journal Frontiers in Pharmacology.

About Noll Campbell, PharmD, MS

In addition to his role as a research scientist at the Regenstrief Institute, Noll Campbell, PharmD, MS, is an assistant professor of pharmaceutical practice at Purdue University College of Pharmacy and an adjunct assistant professor of medicine at the IU School of Medicine.

About Malaz Boustani, MD, MPH

In addition to his role as a research scientist at the Regenstrief Institute, Malaz Boustani, MD, MPH, is the founding director of the Center for Health Innovation and Implementation Science. He is Professor and Richard M. Fairbanks Chair in Aging Research at Indiana University School of Medicine.

About the Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national, and global leader dedicated to a world where better information enables people to end disease and achieve true health. A key research partner of Indiana University, Regenstrief and its researchers are responsible for a growing number of major healthcare innovations and studies. Examples range from developing global health information technology standards that enable the use and interoperability of electronic health records, to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the world.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making health care more efficient and accessible to everyone. His vision continues to guide the institute’s research mission.

About Purdue University College of Pharmacy

The mission of Purdue University College of Pharmacy is to advance scientific discovery and development, maximize global health outcomes through patient care and public service, and educate and train students so that they become leading pharmacists and scientists. The goal is to transform the practice and science of pharmacy to drive progress in human health.

About IU School of Medicine

IU School of Medicine is the largest medical school in the United States and is ranked among the top medical schools in the nation annually by US News & World Report. The school provides high-quality medical education, access to cutting-edge medical research, and rich campus life in nine Indiana cities, including rural and urban areas consistently recognized for their quality of life.

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