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COMMENTS AND OPINIONS
Limitations of the Anticholinergic Risk Scale
Madan Kwatra, PhD
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Delirium is common among elderly hospitalized and surgical patients, and a role for anticholinergic agents in precipitating delirium is well recognized.1 Therefore, we welcome the development of the Anticholinergic Risk Scale (ARS) by Rudolph et al2 to document anticholinergic activity of various drugs. While the ARS has a substantial subjective component, an objective component is provided by the use of the dissociation constant (pKi) of various drugs for the cholinergic receptors. However, Rudolph et al2 do not make clear which cholinergic receptors were used to determine pKi values of various drugs. Of the 2 known classes of cholinergic receptors (nicotinic and muscarinic), only muscarinic receptors are implicated in anticholinergic effects of drugs.3 Therefore, the authors have likely used pKi values of drugs against muscarinic receptors. However, muscarinic receptors are known to have 5 subtypes,4 and it is important to know which subtypes were . . . [Full Text of this Article]
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RELATED ARTICLE
The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons
James L. Rudolph, Marci J. Salow, Michael C. Angelini, and Regina E. McGlinchey
Arch Intern Med. 2008;168(5):508-513.
ABSTRACT
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RELATED LETTER
Limitations of the Anticholinergic Risk Scale—Reply
James L. Rudolph, Marci J. Salow, Michael C. Angelini, and Regina E. McGlinchey
Arch Intern Med. 2008;168(21):2386.
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