Analysis of drug scale with anticholinergic activity

Abstract

Objective: To identify the anticholinergic drug scales and analyse the agreement regarding the drugs included. Methods: This is a descriptive study on scales of drugs with anticholinergic activity. The scales were identified through bibliographical research. The drugs presented in the scales and the systematic classification of the anticholinergic activity score were identified. The drugs included in the scales that were registered with the National Health Surveillance Agency - ANVISA were verified. The drugs included were recorded in an Excel spreadsheet and were classified according to level 3 of the systematic Anatomical Therapeutic Chemistry – ATC of the World Health Organization (WHO). Kappa Fleiss analysis was performed to assess the agreement between the scales in relation to the drugs present. The scales were compared according to the Kappa Cohen statistic. Results: 25 scales for measuring anticholinergic activity were identified. The most recent scale with the largest number of drugs is the Crideco Anticholinergic Activity Scale – CALS. The Anticholinergic Burden Classification – ABC has a smaller number of drugs. Regarding the scoring system, most scales use a score from 0 to 3. In the scales, 347 synthetic drugs and two plant extracts (belladonna and scopolia) were identified. The extracts were considered in this study as a natural product, considering the type of plant present in the extract. For purposes of totaling the numbers of drugs present in the scales, 349 were considered. The most frequent drugs were from subgroup N06A - antidepressants, N05B - anxiolytics and A02B - drugs for peptic ulcer and gastroesophageal reflux disease. The most prevalent pharmacological subgroups were: N06A - antidepressants, N05A - antipsychotics and R06A - antihistamines. Most of the drugs present in the scales had indirect anticholinergic activity. According to Kappa Cohen statistics, only 10 pairs of scales showed moderate agreement. Conclusion: There are 25 scales available for measuring anticholinergic activity. The agreement between the identified scales regarding the drugs included is regular. Considering the drugs included and the pairs of scales, weak and fair agreement prevailed.