Atropinic (Anticholinergic) Burden in Parkinson's Disease

Abstract

Use of atropinic drugs remains controversial in Parkinson's disease (PD) because there is insufficient evidence about their efficacy and they can induce serious adverse drug reactions. Atropinic risk scales were developed to help to identify atropinic drugs in prescription forms and to evaluate their burden in clinical practice. In the present review, we discuss the few studies investigating atropinic burden in PD and present the results of our study indicating that atropinic drugs are still widely prescribed in PD (almost 3 of 5 prescriptions) with a clinically significant atropinic burden in around 1 of 6 PD patients. Drugs mainly responsible for high values of atropinic burden were those used for nonmotor symptoms. Clinically significant atropinic burdens were mainly induced by associations of several "low-risk" drugs. Physicians must be aware that in addition to classical atropinic antiparkinsonian drugs, many others (psychotropics) can contribute to increased atropinic burden in PD patients. © 2016 International Parkinson and Movement Disorder Society.

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

“…Durán's list classifies 100 drugs according to their atropinic level (defined as high or low). We added drugs from the French PIM list as previously done in other studies (see Table S1), updated with drugs recently marketed in France. Fixed drug combinations including two atropinics or one atropinic plus another nonatropinic drug were also included.…”

“…Due to the high prevalence of atropinic drug use in the elderly in France , several recommendations have been proposed to limit the risk of ADRs. Moreover, from 2006 to 2013, the French National Authority for Health (‘Haute Autorité de Santé’, HAS) defined several objectives for improving prescription in the elderly: Among them, it is suggested to reduce atropinic and hypnotic prescriptions .…”

Atropinic (anticholinergic) burden in antipsychotic‐treated patients

“…First, from a clinical point of view, the present data can be compared with those of previous studies performed by our group and using the same methodology in patients with Alzheimer's [15] or Parkinson's [17] diseases. The values were higher in patients receiving antipsychotics: The mean number of atropinics was 2.4 in antipsychotic-treated patients, 0.7 in treated Parkinsonians, and 0.9 in treated Alzheimer's diseases; the mean value of anticholinergic burden per report was 3.9 in thIS study, 0.9 in treated Alzheimer's diseases, and 1.2 in idiopathic Parkinson's disease.…”

Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

“…Although the most recent study did not demonstrate disease‐modifying effect of the earlier initiation of levodopa, there was also no deleterious effect . Furthermore, recent work has demonstrated risks with the use of anticholinergic medications …”

“…10 Furthermore, recent work has demonstrated risks with the use of anticholinergic medications. [11][12][13][14] Despite a large number of data on the efficacy of various pharmacological interventions in PD derived from well-designed controlled studies, there is still a paucity of information on the real-life use of various classes of PD therapeutics. Using the Parkinson's Foundation Quality Improvement Initiative registry collected at participating expert care centers, we analyzed the recent changes in the prescribing practices for the motor symptoms of PD as well as the present-day prescribing landscape.…”