Anticholinergic Activity of Commonly Prescribed Medications and Neuropsychiatric Adverse Events in Older People

Abstract

This study sought to determine whether the presence of in vitro anticholinergic activity (AA) among different drugs is associated with reporting of neuropsychiatric adverse events (NPAEs) and whether age affects this relationship. Retrospective case/noncase analyses using Australia's spontaneous Adverse Drug Reaction System (ADRS) database containing 150 475 reports determined crude and adjusted reporting odds ratios (RORs) for NPAEs for 23 drugs with various reported in vitro AA. Covariates were age (treated as a dichotomous variable [> or =65 years]), gender, and concomitant use of antipsychotics, benzodiazepines, tricyclic antidepressants, and drugs with recognized inherent anticholinergic properties (anticholinergic drugs). The interaction effect between these covariates and each drug exposure category was examined. Age (> or =65 years) has a significant association with greater odds relative to younger age for reporting NPAEs. Drugs with reported significant AA in vitro were not always associated with RORs greater than 1 for reporting NPAEs, highlighting a dissonance between the in vitro AA index and ADRS observations. Significant interactions were observed between age (> or =65 years) and exposure to cimetidine, anticholinergic drugs, antipsychotics, and tricyclic antidepressants in modifying odds for reporting NPAEs, reinforcing the need for cautious use and monitoring of drugs with AA in older people.

Anticholinergic burden and dry mouth among Finnish, community‐dwelling older adults

“…Because the innervations of the salivary glands are complex and it is not clearly known how concomitant use of multiple drugs affects the salivary glands at the receptor‐level, it is difficult to distinguish the main pathways of the xerostomic effect. On the other hand, it is known that the most common way drugs cause dry mouth is by their anticholinergic effect, meaning that xerostomic effects not related to anticholinergicy most likely have only a minor effect on dry mouth. This conception was supported by the fact that additional adjustments for the total number of drugs, antihypertensives or drugs with sedative properties had only a minor influence on the risk estimates.…”

Drug Burden Index in older adults: theoretical and practical issues

“…However, evidence suggests that often the benefits do not justify the risks for some medications in older adults, for example chronic sedative medication use for insomnia 16. There is also significant evidence of an association between anticholinergic medications and neuropsychiatric adverse drug events in older adults 6. Evidence further suggests that clinicians may be less aware that some medications used in older adults, that are not prescribed for their anticholinergic properties, have anticholinergic effects, peripherally and centrally;9 for example, amitriptyline or doxepin for major depressive disorder.…”

“…Some of the most commonly prescribed medications in older people include those with anticholinergic (antimuscarinic)6 and sedative7,8 effects, and inappropriate use of these medications is associated with adverse outcomes 9. For example, studies in older adults have concluded that high use of anticholinergic medications is associated with poor cognitive function10,11 and functional11 impairments.…”

Multiple Anticholinergic Medication Use and Risk of Hospital Admission for Confusion or Dementia

“…Medications with anticholinergic effects are frequently prescribed to older people . Prevalence estimates in people aged 60 to 75 range from 8% to 27% and up to 90% in those aged 75 and older .…”