Background and importance Xerostomia and xerophthalmia are described as common adverse effects of anticholinergic drugs. Recently, anticholinergic scales had been developed to measure the anticholinergic burden, the accumulative effect of anticholinergic drugs. It is not known whether anticholinergic burden could be correlated with xerostomia and/or xerophthalmia.

Aim and objectives The objective was to collect the evidence of the association between anticholinergic burden calculated by different anticholinergic scales or anticholinergic drug use and xerostomia and/or xerophthalmia.

Material and methods A literature search was performed in MEDLINE, EMBASE and CINHALH using terms such as elderly, aged, 80 and over, anticholinergic drugs, anticholinergic burden, xerophthalmia, dry eye, dryness mouth, xerostomia, hyposalivation and dry mouth. Clinical trials and observational articles were selected. The following variables were collected: number of patients, anticholinergic scales used, study duration and statistical association between xerophthalmia or xerostomia and anticholinergic burden or anticholinergic drug use.

Results Articles included=8, numbers of patients=2926. Only five studies used anticholinergic scales: anticholinergic drug scale (three studies), anticholinergic risk scale (two studies). Three studies correlated anticholinergic drug use with xerostomia and/or xerophthalmia. Five were cross sectional studies, one randomised controlled trial and 2 cohort studies. Mean study duration was 5 months (range 2–10 months). Only three studies found a statistical association between xerostomia and anticholinergic burden when comparing patients without an anticholinergic burden and patients with a high anticholinergic burden. No studies found an association between anticholinergic burden and xerophthalmia.

Conclusion and relevance An association was found only in those studies that compared high anticholinergic burden versus no burden for xerostomia, therefore indicating that measurement of anticholinergic burden could be a good method of predicting xerostomia in patients treated with anticholinergic drugs. However, larger studies are necessary to better corroborate this conclusion.

Conflict of interest No conflict of interest