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Ruiz-Ramos J, López-Vinardell L, Higa-Sansone L, Torrecilla-Vall-LLossera B, Puig-Campmany M, Mangues-Bafalluy MA, Juanes-Borrego A. Anticholinergic burden and revisit risk in frail patients with pharmacological sleepiness. Eur J Hosp Pharm 2024; 31:197-200. [PMID: 36100370 DOI: 10.1136/ejhpharm-2022-003424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Drug-induced sleepiness is a frequent cause of emergency department (ED) visits for frail patients. The aim of this study was to assess the impact of anticholinergic burden on 90-day revisitation risk for frail patients who visit the ED due to drug-induced sleepiness. METHODS This was a retrospective study in which patients treated at a fragility care area of an ED who sought consultation for drug-associated sleepiness from June 2020 to June 2021 were included. To evaluate the 90-day revisitation risk factors, a multivariate analysis was performed, including those factors with a p<0.200 from a previous univariate model. A Cox regression model was performed to assess the impact of a high burden on the time until 90-day ED revisitation. RESULTS One hundred and forty-eight patients were included (mean age 80.7±12.3 years). The median number of drugs that patients were currently on at emergency admission was eight (range 2-19), while at hospital discharge it was nine (range 2-20), with the median number of central nervous system (CNS) depressant drugs on admission being three (range 1-6). Thirty-five (23.6%) patients revisited the ED 90 days after discharge for sleepiness or agitation. In the multivariate model, a significant association was observed between a high anticholinergic burden during treatment at discharge (OR 3.74, 95% CI 1.36 to 9.71), chronic kidney disease (OR 2.87, 95% CI 1.19 to 6.81), and the risk of 90-day revisitation. Patients with high anticholinergic burden had a shorter time to revisit than those with medium or low anticholinergic burden (HR 1.96, 95% CI 1.05 to 3.99). CONCLUSIONS Patients with pharmacological sleepiness and a high anticholinergic burden in their chronic treatment carry a greater risk of revisitation to EDs, and should be considered candidates for specific interventions after visiting these units.
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Affiliation(s)
- Jesus Ruiz-Ramos
- Pharmacy Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Ren Y, Qu S. Constituent isoflavones of Puerariae radix as a potential neuroprotector in cognitive impairment: Evidence from preclinical studies. Ageing Res Rev 2023; 90:102040. [PMID: 37619620 DOI: 10.1016/j.arr.2023.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
With the increasing aging population worldwide, the incidence of senile cognitive impairment (CI) is increasing, posing a serious threat to the health of elderly persons. Despite developing new drugs aimed at improving CI, progress in this regard has been insufficient. Natural preparations derived from plants have become an unparalleled resource for developing new drugs. Puerariae radix (PR) has a long history as Chinese herbal medicine. PR is rich in various chemical components such as isoflavones, triterpenes, and saponins. The isoflavones (puerarin, daidzein, formononetin, and genistein) exhibit potential therapeutic effects on CI through multiple mechanisms. Relevant literature was organized from major scientific databases such as PubMed, Elsevier, SpringerLink, ScienceDirect, and Web of Science. Using "Puerariae radix," "Pueraria lobata," "isoflavones," "puerarin," "antioxidant," "daidzein," "formononetin," "genistein," "Alzheimer"s disease," and "vascular cognitive impairment" as keywords, the relevant literature was extracted from the databases mentioned above. We found that isoflavones from PR have neuroprotective effects on multiple models of CI via multiple targets and mechanisms. These isoflavones prevent Aβ aggregation, inhibit tau hyperphosphorylation, increase cholinergic neurotransmitter levels, reduce neuroinflammation and oxidative stress, improve synaptic plasticity, promote nerve regeneration, and prevent apoptosis. PR has been used as traditional Chinese herbal medicine for a long time, and its constituent isoflavones exert significant therapeutic effects on CI through various neuroprotective mechanisms. This review will contribute to the future development of isoflavones present in PR as novel drug candidates for the clinical treatment of CI.
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Affiliation(s)
- Yaoyao Ren
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, 110004 Shenyang, Liaoning, PR China
| | - Shengtao Qu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No. 36 Sanhao St, Shenyang 110004, PR China.
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Tristancho-Pérez Á, Villalba-Moreno Á, López-Malo de Molina MD, Santos-Ramos B, Sánchez-Fidalgo S. The Predictive Value of Anticholinergic Burden Measures in Relation to Cognitive Impairment in Older Chronic Complex Patients. J Clin Med 2022; 11:jcm11123357. [PMID: 35743428 PMCID: PMC9224688 DOI: 10.3390/jcm11123357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Anticholinergic burden (AB) is related to cognitive impairment (CI) and older complex chronic patients (OCCP) are more susceptible. Our objective was to evaluate the predictive value of ten anticholinergic scales to predict a potential CI due to anticholinergic pharmacotherapy in OCCP. An eight-month longitudinal multicentre study was carried out in a cohort of OCCP, in treatment with at least one anticholinergic drug and whose cognition status had been evaluated by Pfeiffer test twice for a period of 6-15 months. CI was considered when the Pfeiffer test increased 2 or more points. AB was detected using ten scales included on the Anticholinergic Burden Calculator. An ROC curve analysis was performed to assess the discriminative capacity of the scales to predict a potential CI and the cut-off point of AB that obtains better validity indicators. 415 patients were included (60.2% female, median age of 85 years (IQR = 11)). 190 patients (45.8%) manifested CI. Only the DBI (Drug Burden Index) showed statistically significant differences in the median AB between patients without CI and with CI (0.5 (1.00) vs. 0.67 (0.65), p = 0.006). At the ROC curve analysis, statistically significant values were obtained only with the DBI (AUC: 0.578 (0.523-0.633), p = 0.006). The cut-off point with the greatest validity selected for the DBI was an AB of 0.41 (moderate risk) (sensitivity = 81%, specificity = 36%, PPV = 51%). The DBI is the scale with the greatest discriminatory power to detect OCCP at risk of CI and the best cut-off point is a load value of 0.41.
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Affiliation(s)
- Ángela Tristancho-Pérez
- Pharmacy Service, Virgen del Rocío University Hospital, 41013 Seville, Spain; (Á.V.-M.); (B.S.-R.)
- Correspondence:
| | - Ángela Villalba-Moreno
- Pharmacy Service, Virgen del Rocío University Hospital, 41013 Seville, Spain; (Á.V.-M.); (B.S.-R.)
| | | | - Bernardo Santos-Ramos
- Pharmacy Service, Virgen del Rocío University Hospital, 41013 Seville, Spain; (Á.V.-M.); (B.S.-R.)
| | - Susana Sánchez-Fidalgo
- Department of Preventive Medicine and Public Health, University of Seville, 41009 Seville, Spain;
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Rekatsina M, Paladini A, Viswanath O, Urits I, Myrcik D, Pergolizzi J, Breve F, Varrassi G. Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review. Pain Ther 2022; 11:381-394. [PMID: 35380373 PMCID: PMC9098742 DOI: 10.1007/s40122-022-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in the central nervous system along with changes in the peripheral nervous system due to aging have a significant impact on pain perception. Sometimes clinicians decide to prescribe opioids to relieve pain, also without a clear indication. This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles that were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by scanning the reference lists of the full-text articles. Discussion This review discusses the complex physiological and pharmacological changes in the elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in the elderly. Information regarding opioid prescription in nursing homes and recorded indications for opioid use, type and dosing of opioids, and compliance of treatment in advanced dementia are also provided. Conclusions Opioid prescription in the elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.
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Affiliation(s)
- M Rekatsina
- Mid and South, Essex University Hospitals Group, Orsett Hospital, Grays, RM16 3EU, Essex, UK
| | - A Paladini
- Department MESVA, University of L'Aquila, 67100, L'Aquila, Italy
| | - O Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - I Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
- Southcoast Physician Group Pain Medicine, Southcoast Health, Wareham, MA, USA
| | - D Myrcik
- Department of Internal Medicine, Silesian University of Medicine, 42-600, Byton, Poland
| | | | - F Breve
- NEMA Research Group, Naples, FL, USA
| | - G Varrassi
- Paolo Procacci Foundation, 00193, Rome, Italy.
- NEMA Research Group (European Chapter), Naples, FL, USA.
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Khodabakhsh P, Bazrgar M, Dargahi L, Mohagheghi F, Asgari Taei A, Parvardeh S, Ahmadiani A. Does Alzheimer's disease stem in the gastrointestinal system? Life Sci 2021; 287:120088. [PMID: 34715145 DOI: 10.1016/j.lfs.2021.120088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 02/07/2023]
Abstract
Over the last decades, our knowledge of the key pathogenic mechanisms of Alzheimer's disease (AD) has dramatically improved. Regarding the limitation of current therapeutic strategies for the treatment of multifactorial diseases, such as AD, to be translated into the clinic, there is a growing trend in research to identify risk factors associated with the onset and progression of AD. Here, we review the current literature with a focus on the relationship between gastrointestinal (GI)/liver diseases during the lifespan and the incidence of AD, and discuss the possible mechanisms underlying the link between the diseases. We also aim to review studies evaluating the possible link between the chronic use of the most common GI medications and the future risk of AD development.
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Affiliation(s)
- Pariya Khodabakhsh
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Bazrgar
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Dargahi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohagheghi
- Institute of Experimental Hematology, Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Afsaneh Asgari Taei
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siavash Parvardeh
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abolhassan Ahmadiani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Trazodone utilization among the elderly in Spain. A population based study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 11:208-215. [DOI: 10.1016/j.rpsm.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/29/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022]
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López-Matons N, Conill Badell D, Obrero Cusidó G, Gil Saladié D, Padrós Selma J, Martin-López A. Anticholinergic drugs and cognitive impairment in the elderly. Med Clin (Barc) 2018. [PMID: 29525116 DOI: 10.1016/j.medcli.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe the prevalence of the anticholinergic drugs (AD) used in patients who consult in regard to loss of memory. Assess the cognitive and functional repercussion of these drugs. PATIENTS AND METHODS Retrospective review of the clinic history of the patients who consulted the clinic in 2015 and 2016. We used the Anticholinergic Cognitive Burden Scale. We explored cognition with the Mini Mental State Examination (MMSE) and function with the Barthel Index and the Lawton and Brody Scale. We compared the difference of scale scores between the patients exposed and not exposed to AD. RESULTS Sample size of 610 patients (mean age=81.1years), 71% female. 37.2% of patients took AD. The mean (SD) difference between exposed and not exposed patients and the year-on-year worsening rate of the Barthel Index and the Lawton and Brody Scale and MMSE were -4 (4.5), -0.3 (0.4) and -1 (0.9), respectively. CONCLUSIONS One third of patients who consulted for cognitive loss are taking AD. Patients exposed to AD show a greater tendency to impairment.
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Marvin V, Ward E, Poots AJ, Heard K, Rajagopalan A, Jubraj B. Deprescribing medicines in the acute setting to reduce the risk of falls. Eur J Hosp Pharm 2017; 24:10-15. [PMID: 28184303 PMCID: PMC5284469 DOI: 10.1136/ejhpharm-2016-001003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Falls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing and polypharmacy contribute to falls risk in elderly patients. This study's aim was to quantify the problem and find out if medication review in the hospital setting led to deprescribing of medicines associated with falls risk. METHODS Admissions records for elderly patients were examined to identify those whose presenting complaint included a fall. Inpatient medication charts, pharmaceutical care notes, medical notes and discharge summaries were examined to identify any falls-risk medicines from admission histories and to determine if any medication review took place, and whether or not changes were made as a result. In particular deprescribing and dose reduction details were analysed. RESULTS 100 patients over 70 years old were admitted following a fall during the 2 months study period. The mean number of medicines on admission was 6.8 per patient with polypharmacy found in 62/100 (62%). One or more falls-risk medicine was found in 65/100 (65%) patients. Medicines review was carried out in 86/100 (86%) of patients, and 59/697 (8.5%) medicines were deprescribed. Pharmacist involvement in medication review led to a significant reduction in the number of falls-risk medicines per patient (p=0.002). CONCLUSIONS Inappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement of a pharmacist improves the rate of reduction of falls-risk medicines.
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Affiliation(s)
- Vanessa Marvin
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Emily Ward
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan J Poots
- NIHR CLAHRC NWL, Imperial College London, London, UK
| | - Katie Heard
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Barry Jubraj
- NIHR CLAHRC NWL, Imperial College London, London, UK
- Institute of Pharmaceutical Sciences, King's College London, London, UK
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Hernández-Arroyo MJ, Díaz-Madero A. [Risk/benefit assessment in the treatment of Alzheimer's disease. Drug interactions]. Rev Esp Geriatr Gerontol 2016; 51:191-195. [PMID: 26775172 DOI: 10.1016/j.regg.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/06/2015] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Anticholinergic drugs reduce the efficacy of acetylcholinesterase inhibitors (AChEI) and are inappropriate in elderly patients. The aim of this study is to determine the prevalence rate of prescription AChEI drugs and anticholinergics in a Healthcare Area, to identify the affected patients, and to inform the attending physicians, in order to evaluate the suitability of treatments. MATERIAL AND METHODS A descriptive cross-sectional observational study of prevalence. Patients on treatment with AChEI and any anticholinergic drug in the first quarter of 2015 were selected. The review of Duran et al. was used as reference to identify anticholinergics, assigning a score to each drug according to its anticholinergic potency. Physicians were provided with a report about the interaction, the list of affected patients, and recommendations. RESULTS A total of 486 patients were included in the study, representing 59.0% of total patients with Alzheimer's disease in the Area. There were 66.0% women, and 86.8% of the patients were older than 75 years, and with a mean of 9.2 drugs per patient. The mean number of anticholinergic drugs was 1.6, and 38.3% of patients were prescribed various anticholinergic drugs, with 23.9% on high potency anticholinergic drugs. A statistically significant association was found between taking an anticholinergic and AChEI concomitantly (P=.000; OR: 3.9). CONCLUSIONS The prevalence of interactions between AChEI and anticholinergic drugs is relevant, considering that it affects vulnerable members of the population. Providing physicians with information about the interaction could help them make clinical decisions, and could improve patient safety, as well as health outcomes.
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Affiliation(s)
| | - Alfonso Díaz-Madero
- Servicio de Farmacia, Gerencia de Atención Primaria de Zamora, Zamora, España
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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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Machado-Alba JE, Castro-Rodríguez A, Álzate-Piedrahita JA, Hoyos-Pulgarín JA, Medina-Morales DA. Anticholinergic Risk and Frequency of Anticholinergic Drug Prescriptions in a Population Older Than 65. J Am Med Dir Assoc 2016; 17:275.e1-4. [DOI: 10.1016/j.jamda.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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12
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Atropinic burden of prescriptions forms in patients with Alzheimer disease: a cross-sectional study in a French PharmacoVigilance Database. Eur J Clin Pharmacol 2015; 71:891-5. [PMID: 25991052 DOI: 10.1007/s00228-015-1869-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
AIM Atropinic drugs in patients with Alzheimer disease (AD) can decrease the effects of anticholinesterase drugs and/or induce adverse drug reactions (ADRs). Several atropinic risk scales defining an atropinic burden of drugs were proposed but were little used in AD patients. METHODS All ADRs' notifications of AD patients registered in the Midi-Pyrénées PharmacoVigilance Database between 1999 and 2013 were analyzed using Anticholinergic Drug Scale (ADS) and Anticholinergic Duran's list. The primary objective was to quantify atropinic burden in AD patients and the secondary one to investigate associated factors. RESULTS Among the 475 notifications, at least one atropinic drug was found in 282 notifications (59.4%) according to ADS and 214 (45.1%) according to Duran. Mean number of atropinics per notifications was 0.9 ± 0.9 (ADS) and 0.7 ± 0.9 (Duran). Mean atropinic burden per notifications was 1.2 ± 1.5 (ADS) and 0.9 ± 1.3 (Duran). Atropinic burden ≥ 3 was found in 87 notifications (18.2%) according to ADS and 50 (10.5%) according to Duran. There was no association between atropinic burden and age of patients. The number of drugs is associated to a high atropinic burden. CONCLUSION The present work found an association between an atropinic drug and an anticholinesterase agent in around 1 out of 2 AD patients and a clinically significant atropinic burden (≥ 3) in around 1 to 2 AD patients out of 10. The benefit harm balance of atropinic drugs must be discussed before each prescription in AD patients.
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