Metoclopramide and Levosulpiride Use and Subsequent Levodopa Prescription in the Korean Elderly: The Prescribing Cascade

Abstract

The aim of this study was to investigate the prescribing cascade phenomenon of dopaminergic drugs such as levodopa in the management of gastroprokinetic drugs induced parkinsonism. Based on the Korea National Health Insurance Service (NHIS)-Senior Cohort Database, we analyzed patients aged ≥65 years, between 2009 and 2013, who obtained new prescriptions for levodopa through the NHIS during this period. Those who were prescribed levodopa from 2002 to 2008 were excluded, only patients who were prescribed metoclopramide and levosulpiride within 90 days of receiving the levodopa prescription were included. Those who did not receive levodopa were used as a control group for 1:3 age and sex matching. We assessed 1824 and 1197 levodopa cases for metoclopramide and levosulpiride use, respectively. The matched controls for each levodopa case were 5472 and 3591, respectively. We used conditional logistic regression to determine the odds ratio (OR) for initiation of levodopa therapy in patients using metoclopramide and levosulpiride, relative to nonusers, after adjusting for age, sex, and exposure to antipsychotic medication. Both metoclopramide (OR = 3.04; 95% confidence interval, CI, 2.46–3.77) and levosulpiride (OR = 3.32; 95% CI, 2.56–4.3) users were three times more likely to begin using medication containing levodopa, compared to nonusers. Metoclopramide and levosulpiride were frequently prescribed within 90 days of receiving a prescription for levodopa. Before prescribing levodopa, it should be considered whether the adverse event is actually a side effect caused by metoclopramide and levosulpiride.

Identifying prescribing cascades in Alzheimer's disease and related dementias: The calcium channel blocker‐diuretic prescribing cascade

“…Prescribing cascades are situations in which multiple treatments and conditions interact and intersect leading to diagnostic errors and preventable drug‐related morbidity. One high‐priority prescribing cascade described includes: (1) calcium channel blocker → edema→ diuretic therapy 2,3 . Calcium channel blockers (CCB) are associated with lower‐extremity edema, and loop diuretics have been used inappropriately to treat CCB‐associated lower extremity edema, constituting a prescribing cascade.…”

Antidopaminergic‐Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease

“…Those in the high exposure group (>30 mg/day and/or duration >5 days) had a 1.83 fold higher risk than standard users (≤30 mg/day and/or duration ≤5 days). In another study from Korea, metoclopramide and levosulpiride users above 65 years of age had almost threefold odds of beginning levodopa therapy relative to non‐users (metoclopramide: OR = 2.94; 95% CI = 2.35–3.67 and levosulpiride: OR = 3.30; 95% CI = 3.52–4.32) 9 . Compared to those who received a shorter duration of the drug (<20 days), the risk of initiation of levodopa therapy for both metoclopramide and levosulpride users increased with increasing duration of therapy beyond 20 days.…”

“…In another study from Korea, metoclopramide and levosulpiride users above 65 years of age had almost threefold odds of beginning levodopa therapy relative to non-users (metoclopramide: OR = 2.94; 95% CI = 2.35-3.67 and levosulpiride: OR = 3.30; 95% CI = 3.52-4.32). 9 Compared to those who received a shorter duration of the drug (<20 days), the risk of initiation of levodopa therapy for both metoclopramide and levosulpride users increased with increasing duration of therapy beyond 20 days. Another case-control study from Korea also reported a higher risk of parkinsonism with exposure to propulsive drugs (OR = 2.82; 95% CI = 2.46-3.21), antipsychotics (OR = 3.0; 95% CI = 1.67-5.43), and flunarizine (OR = 4.95; 95% CI = 2.71-9.04) in the year before the first date of diagnosis of parkinsonism, 8 compared with never users.…”

An examination of three prescribing cascades in a cohort of older adults with dementia

“…The low incidence of this prescribing cascade in NSSPBD compares favourably with other jurisdictions. In a Korean population of adults over 60 years of age, those prescribed metoclopramide were about three times more likely to be prescribed levodopa than those who were not (OR 3.04; 95% CI (2.46-3.77) (4). They also demonstrated that the odds of levodopa prescription increased with increasing duration of metoclopramide treatment (2.82 times for days 1-19 and 4.14 times for > 20 days; both odds ratios were adjusted for age, sex and exposure to antipsychotic medications) (4).…”