Atropinic (anticholinergic) burden in antipsychotic‐treated patients

Abstract

Antipsychotic drugs possess side atropinic (anticholinergic) properties that may induce several adverse drug reactions (ADRs), such as memory loss or cognitive impairment. The aim of this study was to investigate anticholinergic burden in patients treated with antipsychotic drugs. All ADR reports including at least one antipsychotic and registered between 2000 and 2015 in the Midi-Pyrénées PharmacoVigilance Database were extracted and analyzed using the Anticholinergic Duran's list. The primary objective of this cross-sectional study was to calculate anticholinergic burden in antipsychotic-treated patients; the secondary one was to investigate associated factors. Among the 1948 reports, the average number of atropinic drugs per report was 2.4 ± 1.4. At least one atropinic drug was found in 59.4% of reports (1158), in addition to antipsychotic drugs. The mean anticholinergic burden per report was 3.9 ± 2.9. A value ≥3 was found in 61.7% of the reports. A significant association between anticholinergic burden, age, and male gender of patients was found. The mean value of anticholinergic burden remained stable during the study period. This study showed high values of anticholinergic burden in patients receiving antipsychotics. Thus, considering the potential noxious clinical impact of atropinic properties on cognitive functions, an appropriate approach should be used to reduce prescription of antipsychotics with a high anticholinergic burden but also coprescription of other frequently associated atropinic drugs, such as antiparkinsonians, H1 antihistamines, or imipraminic antidepressants in these patients.

Trends of atropinic (anticholinergic) exposure in the elderly: a 10‐year analysis in the French EGB database

“…Secondly, atropinic burden was calculated according to the Durán's classification . High‐potency atropinics were classified at level 3 and low‐potency atropinics at level 1, as already done in previous studies . For combination drugs, we only considered drug with the highest atropinic potency.…”

“…For combination drugs, we only considered drug with the highest atropinic potency. Atropinic burden per patient was defined as the sum of atropinic score for each drug prescribed during a quarter . Values of these two variables were calculated quarterly between 2006 and 2015.…”

Piperazine derivatives with central pharmacological activity used as therapeutic tools

“…The development of compounds with central pharmacological properties containing the piperazine moiety can be an efficient way to synthesize new neuropharmacological drugs. Piperazine derivatives used as medicine drugs 23…”

“…Antipsychotic drugs are used for the treatment of positive and negative symptoms; in general, piperazine derivatives that have antipsychotic effects are multimodal drugs and act on many different receptors, mainly as D 2 dopaminergic antagonists, and they also induce 5HT 2 serotonergic blockade . Table ( 7 to 20 ) lists the piperazine derivatives with main antipsychotic activity and their mechanism of action; this compound has various chemical structures, and the only commonality are the piperazine nuclei as important structures.…”

Antipsychotics inhibit the mitochondrial bioenergetics of pancreatic beta cells isolated from CD1 mice

“…The number of individuals receiving APs worldwide is surprisingly high 3 . APs are classified as either old typical (conventional) or newer atypical APs with different common side effects, including extrapyramidal manifestations, 4 atropine‐like action 5 and metabolic disorders 6 . Since the mid‐1960s, AP treatment was associated with the aggravation of already existing DM or the development of new‐onset type II DM with reported higher risk of hyperglycaemic emergencies 7‐12 …”