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Anticholinergic Burden — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineAnticholinergic BurdenRACP Adult Medicine

An 85-year-old man presents with falls, urinary incontinence, and cognitive decline. His anticholinergic burden score is high. He is taking oxybutynin, amitriptyline, diphenhydramine, and ranitidine. Which medication has the LEAST anticholinergic activity and could be preferentially retained?

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Correct answer: B — Ranitidine

Ranitidine has relatively low anticholinergic activity compared to oxybutynin (strong anticholinergic), amitriptyline (strong), and diphenhydramine (strong). However, all of these medications are on the Beers Criteria list as potentially inappropriate in older adults. The priority for deprescribing should focus on the strong anticholinergics first. Anticholinergic burden is associated with cognitive decline, falls, urinary retention, and delirium in older adults.

Reference: NHMRC/AMS – 2024 – Deprescribing Guidelines; Beers Criteria – 2023 – AGS