Potentially Inappropriate Prescriptions for Anticholinergic Medications for Patients with Constipation

Abstract

Introduction: Constipation is a very common functional gastrointestinal disorder in the general population and can be primary or secondary. Objective: The aim of this study was to estimate the anticholinergic burden of prescribed drugs in a population diagnosed with constipation in Colombia. Methods: This was a cross-sectional study that used a population database of 6.5 million people to identify the prescription of cholinergic antagonists and drugs for the management of constipation in outpatient services. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. Potentially inappropriate prescriptions that increased the risk of constipation were identified. Results: A total of 3,887 patients with constipation were identified; the identified patients had a mean age of 54.4 ± 21.9 years, and 69.4% were women. Eighty percent received at least one laxative, and the most prescribed laxative was bisacodyl (50.5%). Forty-one percent (n = 1,586) of all patients received drugs with cholinergic antagonist activity, in particular codeine (6.5%) and valproic acid (6.5%). Being over 30 years of age (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.24–2.57), being treated in the cities of Manizales (OR: 2.20; 95% CI: 1.50–3.21) and Pereira (OR: 1.49; 95% CI: 1.07–2.09), and having hypothyroidism as a comorbidity (OR: 1.37; 95% CI: 1.08–1.73) were associated with a greater probability of receiving medications with an anticholinergic burden of 3 or more points. Conclusions: The majority of patients with constipation were women and were using laxatives to manage constipation. A large proportion of patients were prescribed at least one cholinergic antagonist drug, with an increased probability of use after 30 years of age.

Patterns of use of medications used to treat urinary incontinence and potentially inappropriate prescriptions

“…In addition to the above findings, one-fifth of the patients who were prescribed antimuscarinics presented with concomitant glaucoma, constipation, sicca syndrome, dementia or prostatic hyperplasia. This is in line with other pharmacoepidemiological studies that documented that the use of antimuscarinic drugs in patients with these pathologies ranged between 22.9% and 41.0% 30 , 31 , 34 – 36 and for which drug–disease interactions could be associated with an increased risk of adverse drug reactions. 8 , 12 , 33 Therefore, the anticholinergic burden at the time of comprehensive treatment of these patients should be taken into account, 3 , 8 , 12 , 32 prolonged-release pharmaceutical forms should be preferentially used, 3 and most importantly, other therapeutic options, such as mirabegron, vaginal estrogens, or nonpharmacological interventions, should be considered.…”

“… 28 These variations can be explained by the characteristics of health systems, the accessibility and availability of drugs in each country, local management guidelines, prescriber preferences, the marketing strategies of the pharmaceutical industry and patient tolerance of the treatment. 30 , 31 These medications are indicated in patients with a diagnosis of urge urinary incontinence with or without overactive bladder who experience persistent symptoms despite conservative treatment. 3 , 6 , 11 In this report, the patients who presented concomitant overactive bladder received the most bladder antimuscarinics and β3-adrenergic agonists, as expected according to management guidelines.…”