¹Institute of Pharmaceutical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany

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Background: Anticholinergic drugs inhibit muscarinic acetylcholine receptors and are used to treat a variety of conditions, such as COPD, depression, Parkinson's disease, overactive bladder, and irritable bowel syndrome [1], [2], [3]. At the same time, they are associated with adverse effects, including an increased risk of cognitive decline, falls, and mortality [2], [4], [5].

However, despite the clinical relevance of assessing the anticholinergic burden (AB) as the additive effect of medications with varying anticholinergic potencies [6], national data on real-world exposure and utilization patterns, particularly including over-the-counter (OTC) use, remain scarce for Germany.

Materials and Methods: Using baseline data (2014–2019) from the German National Cohort (NAKO; >200,000 individuals) [7], [8], we conducted a preliminary, descriptive pharmacoepidemiologic analysis of anticholinergic medication use. AB was calculated as the sum of individual drug ratings using a validated scoring system adapted to medications available in Germany (German Anticholinergic Burden Scale, GABS), mapping prescribed and OTC drugs to graded burden scores from 0 (no anticholinergic effects) to 3 (strong anticholinergic effects) [9], [10].

Results: In our dataset, 17.1% of participants were exposed to anticholinergic medications, with 2.9% reaching a GABS score ≥3. Mean burden was higher in women than in men (0.31 ± 0.83 vs. 0.24 ± 0.69) and increased with age (0.12 in those aged 20–29 years to 0.47 in those aged ≥70 years). Medications from the nervous system, cardiovascular system, and alimentary tract/metabolism ATC classes contributed most to overall AB. OTC drugs accounted for 12.6% of all anticholinergic agents.

Conclusion: Our findings reveal anticholinergic exposure in a large German cohort, highlight demographic differences, and underscore the importance of considering OTC medications in burden surveillance. These insights can inform future association- and outcome-focused research.

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