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Bourrel C, Zacarin A, Rousseau V, Montastruc JL, Bagheri H. Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects? Fundam Clin Pharmacol 2020; 34:743-748. [PMID: 32289182 DOI: 10.1111/fcp.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 12/13/2022]
Abstract
The PAAPI project (Optimising Inappropriate Prescriptions in the Elderly) is a multi-disciplinary approach put in place by the Toulouse Pharmacovigilance Centre (CRPV) in order to improve drug prescribing practice in nursing homes. The aim of this study was to analyse the association between polypharmacy, frequency of prescriptions for potentially inappropriate medications (PIMs) and the anticholinergic burden of prescriptions in elderly patients from the PAAPI cohort. We carried out a retrospective study on residents of 24 nursing homes (EHPAD) participating in the PAAPI programme between 1er January 2017 and 31 December. Resident's Data were collected in a single review in a random day. Drug prescriptions were analysed quantitatively and qualitatively. PIMs and anticholinergic drugs were identified by the list EU(7)PIM and the Duran scale, respectively. The total anticholinergic burden was calculated by adding the anticholinergic scores of each drug. We classified the drugs into three categories: no anticholinergic burden (burden = 0), low anticholinergic burden (≥1 ≤ 3) or high anticholinergic burden (burden > 3). A total of 1191 residents living were included, and we analysed 8869 drug prescription lines. The average age of the residents was 87.0 ± 8.3 years, and the majority (71.5%) were female. Nearly half of the residents (49.6%, n = 67) having a prescription with a high anticholinergic burden were taking more than 9 drugs (Fisher exact test P < 0.05). All the prescriptions with more than 5 PIMs (n = 23) had an anticholinergic burden > 0, with the majority (65.2%, n = 15) having a high anticholinergic burden (Kruskal-Wallis test, P < 0.0001). In this cohort, 88% (n = 539) of prescriptions with a low anticholinergic burden and 100% (n = 135) of prescriptions with a high anticholinergic burden included at least one PIM. According to our study, the anticholinergic burden of prescriptions given to residents in the PAAPI cohort is associated with the prescription of PIMs and with polypharmacy. Optimizing the use of medicines remains essential in this population, given the harmful properties of these drugs. It would also be useful for the list of anticholinergic drugs to be updated as new medicines come onto the market.
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Affiliation(s)
- Claire Bourrel
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Alice Zacarin
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Jean-Louis Montastruc
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Haleh Bagheri
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
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de Germay S, Rueter M, Montastruc F, Rousseau V, Lapeyre-Mestre M, Montastruc JL. Trends of atropinic (anticholinergic) exposure in the elderly: a 10-year analysis in the French EGB database. Fundam Clin Pharmacol 2019; 33:471-478. [PMID: 30687946 DOI: 10.1111/fcp.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
Atropinic drugs are known to potentially induce physical and/or mental impairments in the elderly. The aim of this study was to investigate trends of atropinic exposure in patients ≥65 years in France between 2006 and 2015. A repeated cross-sectional study was performed quarterly from January 1, 2006 to December 31, 2015, in the 'Echantillon Généraliste des Bénéficiaires (EGB)', a representative sample of the French population. Exposed patients were identified using the Anticholinergic Durán's list. Outcomes were rate of patients exposed to at least one atropinic drug (atropinic prevalence rate) and atropinic burden per patient (sum of atropinic burden scores). Interrupted time series were used to analyze the impact of market withdrawal of some drugs with atropinic properties during the period of the study. The number of patients ≥65 years registered in the EGB ranged from 75 611 in 2006 to 95 389 in 2015. Atropinic prevalence rate decreased significantly from 45.6% in 2006 to 33.2% in 2015 (-12.4%, slope significance P < 0.05). Subjects aged ≥85 years were the most exposed. Total atropinic burden decreased significantly between 2006 and 2015 (2.2 ± 1.7 in 2006; 2.0 ± 1.5 in 2015; slope significance P < 0.05), especially in patients ≥85 years. Market withdrawals for safety reasons of some atropinic drugs were significantly associated with a decrease in the atropinic prevalence rate (P < 0.05) and atropinic burden per patient (P < 0.05). In conclusion, atropinic drug exposure in the elderly significantly decreased in France between 2006 and 2015. This decrease can be partly explained by regulatory measures against some atropinic drugs.
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Affiliation(s)
- Sibylle de Germay
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Manuela Rueter
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre d'Evaluation et d'Information sur la PharmacoDépendance et d'AddictoVigilance (CEIP-A), 37 allées Jules Guesde, 31000, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
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Benevent J, Hurault-Delarue C, Araujo M, Montastruc F, Montastruc JL, Lacroix I, Damase-Michel C. Higher intake of medications for digestive disorders in children prenatally exposed to drugs with atropinic properties. Fundam Clin Pharmacol 2018; 33:314-326. [PMID: 30365180 DOI: 10.1111/fcp.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022]
Abstract
Childhood digestive disorders are a common occurrence and are sometimes unexplained. Maternal medication during the development of the foetus' digestive system may contribute to the increase in childhood digestive disorders, especially with drugs acting on the cholinergic system. This study investigated the association between prenatal exposure to drugs with atropinic properties and the use of digestive disorder medications in childhood (0-3 years). Children from POMME (PrescriptiOn Médicaments Mères Enfants), a French database of reimbursed drugs for pregnant women and their children, were included (N = 8 372). Each drug prescribed during antenatal life was assigned an atropinic score (0 = null, 1 = low, 3 = strong). The prenatal atropinic burden was calculated as the sum of atropinic scores of drugs prescribed. More than 30% (N = 2 652) of the children were prenatally exposed to atropinic drugs. They used significantly more digestive disorder medications than unexposed children (RRa = 1.11 [1.06; 1.16]). The strength of the association increased with the prenatal atropinic burden. Our results suggest long-term digestive effects after prenatal exposure to atropinic drugs.
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Affiliation(s)
- Justine Benevent
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Caroline Hurault-Delarue
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Mélanie Araujo
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Isabelle Lacroix
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
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Andre L, Gallini A, Montastruc F, Coley N, Montastruc JL, Vellas B, Andrieu S, Gardette V. Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3-year analysis of the multidomain Alzheimer preventive trial (MAPT) study. Br J Clin Pharmacol 2018; 85:71-99. [PMID: 30098049 DOI: 10.1111/bcp.13734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/19/2018] [Accepted: 07/27/2018] [Indexed: 01/02/2023] Open
Abstract
AIM The aim of the present study was to assess the association between anticholinergic (atropinic) burden and cognitive decline in older adults over the course of 3 years. METHODS We used data from Multidomain Alzheimer Preventive Trial (MAPT) study participants aged ≥70 years and at risk of cognitive decline. Cognitive function was assessed with a composite score [Mini-Mental State Examination (MMSE) orientation, Free and Cued Selective Reminding Test, Category Naming Test, Digit Symbol Substitution Test] at 12, 24 and 36 months. Participants declining by more than 0.236 points on the composite score (representing the lowest quintile of 1-year cognitive change) during any 1-year period were considered to have undergone cognitive decline. Anticholinergic exposure was defined by four methods for each of four anticholinergic scales (Anticholinergic Drug Scale, Anticholinergic Cognitive Burden, Anticholinergic Risk Scale, the Durán list). The association between cognitive decline and time-varying anticholinergic exposure [primary analysis using the Durán list and maximal anticholinergic score (0, 1 or 3)] was assessed using Cox proportional hazards models. Other cognitive decline definitions were used in sensitivity analyses. RESULTS At baseline, among 1396 patients included, 7.4-23.5% were exposed to anticholinergic agents, depending on the anticholinergic scale used. Sixty-four per cent of participants experienced cognitive decline during follow-up. Regardless of the anticholinergic scale/exposure measurement used, no significant association was observed with cognitive decline {primary analysis: compared with non-anticholinergic agent users, hazard ratio [HR] = 1.14 [95% confidence interval (CI) = 0.95, 1.38] for anticholinergic score = 1; HR = 0.92 [95% CI = 0.65, 1.30] for score = 3}. Results were stable in sensitivity analyses. CONCLUSION We found no significant association between anticholinergic exposure and cognitive decline in older adults using anticholinergic scales and definitions of exposure.
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Affiliation(s)
- Laurine Andre
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Adeline Gallini
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - François Montastruc
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Nicola Coley
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Jean-Louis Montastruc
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Bruno Vellas
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Sandrine Andrieu
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Virginie Gardette
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
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5
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de Germay S, Lapeyre-Mestre M, Montastruc JL, Montastruc F. [Atropinic burden and anticholinergic drugs: Interest and application in clinical practice in the elderly]. Therapie 2018; 76:665-673. [PMID: 29625707 DOI: 10.1016/j.therap.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
Abstract
Anticholinergic drugs (also called antimuscarinics or atropinics) increase the risk of falls, cognitive impairment and/or mortality in older patients. These drugs belong to the lists of potentially inappropriate medications in the elderly. The aim of this review was to present and discuss the different tools available to measure the atropinic risk in drug exposure of older patients. Several scales, developed from biological and/or clinical criteria, allow to classify anticholinergic drugs according to their atropinic potency and to assign to them an atropinic burden. Total atropinic burden of patient drug exposure can be calculated as the sum of atropinic score of each drug. Other tools include drug daily doses to better estimate the atropinic risk. These different methods are a precious help to decrease atropinic exposure in the elderly. Nevertheless, they have to be considered as upgradable and it is necessary to adapt them regularly according to the introduction of new drugs in clinical practice.
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Affiliation(s)
- Sibylle de Germay
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées d'évaluation et d'information sur la pharmacodépendance et d'addictovigilance (CEIP-A), centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
| | - François Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
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Montastruc F, Benevent J, Touafchia A, Chebane L, Araujo M, Guitton-Bondon E, Durrieu G, Arbus C, Schmitt L, Begaud B, Montastruc JL. Atropinic (anticholinergic) burden in antipsychotic-treated patients. Fundam Clin Pharmacol 2017; 32:114-119. [DOI: 10.1111/fcp.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/01/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- François Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
- Département de Pharmacologie Médicale; INSERM U 1219 “Médicaments et Santé des Populations”; Université de Bordeaux; Bordeaux France
| | - Justine Benevent
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Anthony Touafchia
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Leila Chebane
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Mélanie Araujo
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Emmanuelle Guitton-Bondon
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Geneviève Durrieu
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Christophe Arbus
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Laurent Schmitt
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Bernard Begaud
- Département de Pharmacologie Médicale; INSERM U 1219 “Médicaments et Santé des Populations”; Université de Bordeaux; Bordeaux France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
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Gutiérrez-Valencia M, Martínez-Velilla N, Vetrano DL, Corsonello A, Lattanzio F, Ladrón-Arana S, Onder G. Anticholinergic burden and health outcomes among older adults discharged from hospital: results from the CRIME study. Eur J Clin Pharmacol 2017; 73:1467-1474. [DOI: 10.1007/s00228-017-2312-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
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De Germay S, Montastruc JL, Rousseau V, Chebane L, Bondon-Guitton E, Moulis F, Durrieu G, Bagheri H, Rascol O, Pariente A, Bégaud B, Montastruc F. Atropinic (Anticholinergic) Burden in Parkinson's Disease. Mov Disord 2016; 31:632-6. [DOI: 10.1002/mds.26595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sibylle De Germay
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
- CIC INSERM 1436; Université et Centre Hospitalier Universitaire de Toulouse; Toulouse France
- NeuroToul Centre of Excellence in Neurodegeneration; Université et Centre Hospitalier Universitaire; France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
- CIC INSERM 1436; Université et Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Leila Chebane
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Emmanuelle Bondon-Guitton
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
| | - Florence Moulis
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Genevieve Durrieu
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Haleh Bagheri
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
- NeuroToul Centre of Excellence in Neurodegeneration; Université et Centre Hospitalier Universitaire; France
| | - Olivier Rascol
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- CIC INSERM 1436; Université et Centre Hospitalier Universitaire de Toulouse; Toulouse France
- NeuroToul Centre of Excellence in Neurodegeneration; Université et Centre Hospitalier Universitaire; France
- INSERM UMR 825; Université de Toulouse; Toulouse France
| | - Antoine Pariente
- Département de Pharmacologie; Université et Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
- INSERM U 657, Pharmacoepidemiology; Université et Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Bernard Bégaud
- Département de Pharmacologie; Université et Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
- INSERM U 657, Pharmacoepidemiology; Université et Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique; Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse; Toulouse France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées; Centre Hospitalier Universitaire de Toulouse; Toulouse France
- INSERM UMR 1027, Faculté de Médecine; Université de Toulouse; Toulouse France
- CIC INSERM 1436; Université et Centre Hospitalier Universitaire de Toulouse; Toulouse France
- NeuroToul Centre of Excellence in Neurodegeneration; Université et Centre Hospitalier Universitaire; France. Département de Pharmacologie; Université et Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
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Lertxundi U, Isla A, Solinis MA, Domingo-Echaburu S, Hernandez R, Peral-Aguirregoitia J, Medrano J. Anticholinergic burden in Parkinson's disease inpatients. Eur J Clin Pharmacol 2015; 71:1271-7. [PMID: 26254777 DOI: 10.1007/s00228-015-1919-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/28/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients. METHOD We analyzed information from different administrative Basque Country's healthcare databases using encrypted unique identifiers in order to detect PD patients admitted to public acute care hospital during 2011-2012. Subsequently, anticholinergic burden was measured using Duran et al.'s list. Secondarily, total anticholinergic load was assessed with the Anticholinergic Drug Scale, the Anticholinergic Risk Score, and the Anticholinergic Burden Scale. A logistic regression model was performed to study association of predictive variables with anticholinergic use. RESULTS A high proportion of PD patients were prescribed anticholinergic drugs, with 53.6% of admissions receiving at least one drug from Duran et al.'s "low-risk" and 10% at least "high-risk" drug. Drugs used for non-motor symptoms and other comorbidities other than PD itself contributed significantly to anticholinergic burden, namely antidepressants, antipsychotics, urological drugs, analgesics, and antihistamines, among others. The total number of drugs and cholinesterase inhibitors were independently associated with anticholinergic drug use. CONCLUSIONS Anticholinergic burden in PD patients is significant, and is caused mostly by drugs not used for PD motor symptoms. Polypharmacy and cholinesterase inhibitors were independently associated with anticholinergic drug prescriptions.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba's Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain.
| | - Arantxazu Isla
- Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain.
| | - Maria Angeles Solinis
- Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain.
| | - Saioa Domingo-Echaburu
- Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa, 16, 20500, Arrasate, Gipuzkoa, Spain
| | - Rafael Hernandez
- Internal Medicine Service, Araba´s Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain.
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia´s Mental Health Network, Portugalete, Spain.
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