Download Extended Drug Burden Score (eDBS)

Extended Drug Burden Score (eDBS)
Medscope has implemented a system for calculating the combined sedative and anticholinergic drug burden of each
patient’s medication regimen. The system uses available anticholinergic and sedative ratings for commonly used
agents and calculates a total burden based on each patient’s daily dose of the relevant medications.
The resulting Extended Drug Burden Score (EDBS) provides some indication of the possible impact that the
psychoactive medications may have on the patient. Medscope provides a summary of the potential impact and the
details of the agents involved.
What the scores mean:
eDBS between 0 and 1.0: This patient is taking one or more centrally acting agents and is at some risk of
interference with cognition, balance/mobility and functional status. This risk may be significant if the patient
has impairment in any of the non-zero eBDS domains.
eDBS between 1.0 and 3.0: This patient is taking a number of centrally acting agents and is at moderate risk
of interference with cognition, balance/mobility and functional status. This risk may be significant if the
patient has impairment in any of the non-zero eBDS domains.
eDBS between 3.0 and 5.0: This patient is taking a significant number of centrally acting agents and is at
considerable risk of interference with cognition, balance/mobility and functional status. This risk may be
significant if the patient has impairment in any of the non-zero eBDS domains.
eDBS greater than 5.0: This patient has a very high level of use of centrally acting agents and is at major risk
of interference with cognition, wakefulness, balance, mobility and functional status.
Calculation of Extended Drug Burden Score (EDBS) for each Patient
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Each drug with anticholinergic properties was allocated a score from 0-3 based on literature values.1 These
values (0-3) were divided by 3 to result in a Drug Burden (DB) score of 0-1 (0, 0.33, 0.66 and 1)
Each drug was assessed for sedative properties (based on publically available adverse effect information) and
those with sedation as a side effect were allocated an Drug Burden (DB) score of 1.0
Commonly used drugs in the Medscope database were assigned a WHO Defined Daily Dose (DDD) which is
the average maintenance dose for its main indication.2
The daily dose of each drug the patient is taking with either sedative or anticholinergic properties is used to
allocate a drug specific DB score3 based on the formula:
(Drug Dose x DB)/(Drug Dose + DDD)= drug specific DB
5.
The Extended Drug Burden Score is calculated by summing the drug specific scores for each drug the patient
is taking
Disclaimer
Note that the EDBS is simply a guide to the quantum of centrally acting agents and may not be relevant
in some situations.
Incorrectly entered/calculated or absent doses recorded on the patient’s medication profile will impact on
the EDBS result.
Not every medication in the Medscope database has DDD or DB scores allocated, so some EDBS results
may appear inappropriately low. Pharmacists are advised to use their clinical discretion in these
situations.
Reference http://www.medscope.com.au/documents/eDBSRef.pdf
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3
Arch Intern Med. 2008;168(5):508-513
http://www.whocc.no/atc_ddd_index
Where a drug has both anticholinergic and sedative properties, a DB score of 1.0 was assigned