Anticholinergic Burden Calculator
How to Use This Calculator
Anticholinergic burden scores help assess risk from multiple medications. The goal is to keep your total score under 2, especially if you're over 65.
Each medication has a score (0-2):
- 0 = No anticholinergic effect
- 1 = Mild effect
- 2 = Strong effect
Click 'Calculate' after selecting your medications to see your total score and risk level.
Your Medications
Your Anticholinergic Burden Score
0
Low Risk
Your total anticholinergic burden score: 0
Important Information
What does your score mean?
- 0-1 = Low risk for side effects
- 2-3 = Moderate risk (be cautious)
- 4+ = High risk (consult your doctor)
Why it matters: If you're over 65, the risks increase significantly. A score of 2 or higher increases your risk of confusion, falls, and memory problems.
Always consult your doctor before making any changes to your medications. This calculator is for informational purposes only.
When you take an antispasmodic like dicyclomine or hyoscine for stomach cramps or irritable bowel syndrome, you might not think about the other pills in your medicine cabinet. But combining these drugs with common medications-like allergy pills, sleep aids, or antidepressants-can lead to serious side effects. These aren’t just theoretical risks. Real patients report confusion, extreme dry mouth, blurred vision, and even hospitalizations because they didn’t know their meds were clashing.
How Anticholinergic Antispasmodics Work
Antispasmodics like dicyclomine and hyoscine work by blocking acetylcholine, a chemical your body uses to signal muscles to contract. In the gut, bladder, or airways, this helps calm spasms. But acetylcholine isn’t just in your intestines-it’s everywhere. It controls salivation, heart rate, pupil size, and even memory. When you block it too broadly, side effects follow.These drugs don’t just affect your digestive system. They can slow down your whole nervous system. That’s why people on these medications often feel dizzy, have trouble urinating, or see things go blurry. For older adults, the risks are even higher. The brain relies on acetylcholine to stay sharp. Blocking too much of it can mimic dementia-confusion, memory loss, hallucinations. That’s why the American Geriatrics Society lists several anticholinergic antispasmodics as potentially inappropriate for people over 65.
Common Medications That Clash with Antispasmodics
You might not realize it, but many everyday drugs have anticholinergic properties. When you stack them with your antispasmodic, the effects add up. Here’s what to watch for:- Antihistamines like diphenhydramine (Benadryl) or chlorpheniramine-common in cold and allergy meds. These are strong anticholinergics. Mixing them with dicyclomine can cause severe dry mouth, constipation, or urinary retention.
- Tricyclic antidepressants like amitriptyline or nortriptyline. Patients on these for nerve pain or depression often report their antispasmodic stops working, then they develop worsening constipation or confusion.
- Antipsychotics such as olanzapine or quetiapine. These are designed to block brain receptors, and adding an antispasmodic pushes the system over the edge.
- Bladder control drugs like oxybutynin or tolterodine. Taking these with another anticholinergic antispasmodic is like doubling the dose. One Reddit user described it as ‘feeling like my brain was foggy and my body wouldn’t cooperate.’
- Sleep aids containing doxylamine or diphenhydramine. These are often sold as ‘natural’ or ‘herbal’ solutions, but they’re chemically identical to strong anticholinergics.
Even some over-the-counter stomach remedies contain anticholinergics. Check labels for ingredients like belladonna alkaloids. They’re hiding in plain sight.
Real Patient Stories
On Drugs.com, a woman with IBS wrote: ‘I started amitriptyline for nerve pain. Within a week, my dicyclomine didn’t help my cramps anymore, and I hadn’t had a bowel movement in five days. I ended up in the ER.’ Another user said: ‘I took Benadryl for allergies and oxybutynin for bladder issues. I couldn’t see the TV. I thought I was having a stroke.’Pharmacists in online forums report the same pattern. One wrote: ‘I’ve had to step in three times this month because a patient got prescribed an anticholinergic by their gastroenterologist, another by their psychiatrist, and a third by their allergist. No one talked to each other.’
These aren’t rare cases. A 2023 study in JAMA Internal Medicine found that when hospitals started using automated tools to flag these combinations, inappropriate prescribing dropped by 43%. That means hundreds of people were being put at risk-and no one noticed until the system did.
The Anticholinergic Burden Scale
Doctors now use a simple tool called the Anticholinergic Cognitive Burden Scale to measure risk. Each medication gets a score: 0 (no effect), 1 (mild), or 2 (strong). If your total score is 2 or higher, you’re at increased risk for confusion, falls, and memory problems.Here’s how common drugs stack up:
| Medication | Use | Anticholinergic Score |
|---|---|---|
| Dicyclomine | IBS, cramps | 2 |
| Hyoscine (scopolamine) | Motion sickness, GI spasms | 2 |
| Oxybutynin | Overactive bladder | 2 |
| Amitriptyline | Depression, nerve pain | 2 |
| Diphenhydramine (Benadryl) | Allergies, sleep | 2 |
| Chlorpheniramine | Allergies | 1 |
| Hydroxyzine | Anxiety, itching | 2 |
| Carbamazepine | Seizures | 1 |
Many people don’t realize they’re hitting the danger zone. If you’re taking two medications with a score of 2, your total is 4. That’s high risk. Even one 2-point drug plus two 1-point drugs adds up to 4. The goal? Keep your total under 2, especially if you’re over 65.
What to Do If You’re on Antispasmodics
If you’re currently taking dicyclomine, hyoscine, or another anticholinergic antispasmodic, here’s what to do:- Make a full list of every medication you take-prescription, over-the-counter, supplements, even herbal teas. Include dosages and how often you take them.
- Check each one against the anticholinergic burden scale. Use the University of Washington’s free online calculator or ask your pharmacist.
- Ask your doctor: ‘Is this drug necessary? Is there a safer alternative?’ For IBS, alternatives like peppermint oil capsules, fiber supplements, or low-dose SSRIs may work without the risk.
- Never stop cold turkey. Some anticholinergics cause rebound symptoms. Work with your provider to taper safely.
- Watch for warning signs: dry mouth, trouble peeing, constipation lasting more than three days, blurred vision, confusion, or memory lapses. Call your doctor immediately if these appear.
Why This Is Getting Worse
Prescriptions for anticholinergic antispasmodics dropped 22% between 2018 and 2022. Why? Because doctors are waking up. The European Medicines Agency now requires warning labels on packaging about interactions with CNS depressants. The FDA has boxed warnings for use in glaucoma, myasthenia gravis, and urinary blockage.But the problem isn’t just doctors. It’s fragmented care. One specialist prescribes an antispasmodic. Another prescribes an antidepressant. A third gives you a sleep aid. No one talks. No one checks the total burden.
Electronic health records now have alerts, but they’re not perfect. If you see a new doctor or fill a prescription at a different pharmacy, the system might miss the combo. That’s why you have to be your own advocate.
What’s Next
Newer antispasmodics are being developed that work only in the gut-without crossing into the brain. Two are in late-stage trials as of late 2023. These could replace dicyclomine and hyoscine for many patients, especially older adults.For now, the safest approach is simple: avoid stacking anticholinergics. If you need a muscle relaxant for your gut, ask if there’s a non-anticholinergic option. If you’re on an antidepressant or allergy med, ask if it’s contributing to your symptoms. And if you’re over 65, assume any anticholinergic drug is a red flag unless proven otherwise.
The goal isn’t to scare you off helpful medications. It’s to help you see the full picture. Your body doesn’t treat each pill separately. It sees the whole stack. And sometimes, the whole stack is too much.
Can I take antispasmodics with ibuprofen?
Yes, ibuprofen doesn’t have anticholinergic effects and doesn’t interact with dicyclomine or hyoscine. It’s generally safe to take together for pain and cramps. But don’t combine them long-term without checking with your doctor, especially if you have kidney issues or stomach sensitivity.
Are there antispasmodics without anticholinergic effects?
Yes. Calcium channel blockers like cinnarizine and peppermint oil capsules are non-anticholinergic options for IBS and GI spasms. Peppermint oil, in particular, has strong evidence for reducing cramping without the cognitive or urinary side effects. Some doctors now recommend it as a first-line treatment.
Why do anticholinergics cause constipation?
Acetylcholine tells your intestines to contract and move food along. When anticholinergics block it, your gut slows down. This isn’t just uncomfortable-it can lead to dangerous bowel obstructions, especially in older adults or those already prone to constipation. That’s why doctors now warn against using these drugs in people with slow digestion.
Can anticholinergic interactions cause dementia?
Long-term use of high-anticholinergic medications is linked to a higher risk of dementia, especially in people over 65. A 2019 study in JAMA found that taking strong anticholinergics for three years or more increased dementia risk by 54%. It’s not that they cause dementia directly, but they accelerate cognitive decline in vulnerable brains. Stopping them early can reduce this risk.
What should I do if I’m on multiple anticholinergics?
Don’t panic, but don’t ignore it. Schedule a medication review with your pharmacist or doctor. Bring your complete list. Ask: ‘What’s the lowest possible dose?’ and ‘Is there a safer alternative for any of these?’ Many people can switch to non-anticholinergic options with better outcomes and fewer side effects.
Is it safe to take antispasmodics if I’m over 65?
It’s generally not recommended. The American Geriatrics Society advises avoiding these drugs in older adults because the risks-confusion, falls, urinary retention-often outweigh the benefits. If absolutely necessary, use the lowest dose for the shortest time possible, and monitor closely for side effects. Alternatives like dietary changes, fiber, or peppermint oil are safer first steps.
Next Steps
If you’re taking an antispasmodic, don’t wait for a problem to happen. Take action now:- Download the Anticholinergic Burden Calculator from the University of Washington website.
- Write down every medication you take, including supplements and OTC drugs.
- Book a 15-minute appointment with your pharmacist to review your list.
- If you’re over 65, ask your doctor: ‘Is this drug still right for me?’
Medications aren’t just about what they fix-they’re about what they break. And sometimes, the damage isn’t obvious until it’s too late. Stay informed. Stay alert. Your brain and your gut will thank you.
Laura Rice
I took dicyclomine for years and never knew it was making me feel like my brain was wrapped in cotton. Then I started taking Benadryl for allergies and suddenly I couldn’t remember where I put my keys-or my name. I thought I was losing it. Turns out, I was just overdosing on anticholinergics. My pharmacist caught it. I cried. Then I switched to peppermint oil. Best decision ever.
charley lopez
The pharmacokinetic and pharmacodynamic interactions between anticholinergic agents are well-documented in the literature, particularly with regard to muscarinic receptor occupancy and central nervous system penetration. The cumulative anticholinergic burden scale, as proposed by the American Geriatrics Society, provides a clinically validated framework for risk stratification. However, real-world polypharmacy often exceeds the thresholds of automated EHR alerts due to fragmented prescribing patterns across specialties.
Kerry Evans
People just don’t take responsibility anymore. You take a drug that makes you foggy? That’s your fault. No one forced you to stack Benadryl with your IBS med. If you can’t read a label or ask your doctor, don’t blame the system. I’ve seen patients on seven anticholinergics and then act shocked when they can’t walk straight. Wake up. Your body isn’t a lab experiment.
Kerry Moore
Thank you for this comprehensive overview. I have been reviewing anticholinergic burden with my elderly patients for the past year, and the data is unequivocal. The 2019 JAMA study on dementia risk, coupled with the 2023 JAMA Internal Medicine intervention data, provides compelling evidence for proactive medication reconciliation. I now routinely employ the University of Washington calculator during annual wellness visits and have observed a 68% reduction in reported cognitive side effects since implementation.
Janet King
Check your meds. That’s it. Write them all down. Bring them to your pharmacist. Ask if any are hurting you more than helping. Simple. No fancy science needed. Just care.
Andrew Smirnykh
This is such an important topic. In my country, people often get prescriptions from multiple doctors without any coordination. I’ve seen elderly relatives confused because they didn’t realize their sleep aid was the same chemical as their allergy pill. We need better systems-but also better conversations. Maybe this post can start that.
Oladeji Omobolaji
Man, I thought I was just old. I been takin’ diphenhydramine for sleep and dicyclomine for my guts. Felt like my head was fulla smoke. Didn’t know it was the drugs. Now I use chamomile tea and a heating pad. No more brain fog. Peace.
Vanessa Barber
Actually, most of this is exaggerated. I’ve been on amitriptyline and dicyclomine for 10 years and I’m fine. Your brain’s just weak if you can’t handle a little dry mouth.
Stacy Thomes
STOP. RIGHT. NOW. If you’re over 65 and taking ANY of these, you’re playing Russian roulette with your brain. I’m not exaggerating. My mom ended up in the hospital because she didn’t know her allergy meds were doing this. She thought it was ‘just aging.’ It wasn’t. It was preventable. Go check your meds TODAY. I mean it. I’ll wait.