Unax Lertxundi1, Arantxazu Isla2, Maria Angeles Solinis3, Saioa Domingo-Echaburu4, Rafael Hernandez5, Javier Peral-Aguirregoitia6, Juan Medrano7. 1. Pharmacy Service, Araba's Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain. unax.lertxundietxebarria@osakidetza.net. 2. Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain. arantxa.isla@ehu.es. 3. Pharmacy and Pharmaceutic Technology Department, Pharmacy Faculty, University of theBasque Country UPV/EHU, Paseo de laUniversidad 7, 01006, Vitoria-Gasteiz, Araba/Álava, Spain. marian.solinis@ehu.es. 4. Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa, 16, 20500, Arrasate, Gipuzkoa, Spain. 5. Internal Medicine Service, Araba´s Mental Health Network, C/alava 43, 01006, Vitoria-Gasteiz, Alava, Spain. rafael.hernandezpalacios@osakidetza.net. 6. Pharmacy Service, Hospital Galdakao-Usánsolo, Barrio labeaga s/n., Galdakao, Vizcaya, Spain. javier.peralaguirregoitia@osakidetza.net. 7. Psychiatry Service, Bizkaia´s Mental Health Network, Portugalete, Spain. juan.medranoalbeniz@osakidetza.net.
Abstract
PURPOSE: Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients. METHOD: We analyzed information from different administrative Basque Country's healthcare databases using encrypted unique identifiers in order to detect PD patients admitted to public acute care hospital during 2011-2012. Subsequently, anticholinergic burden was measured using Duran et al.'s list. Secondarily, total anticholinergic load was assessed with the Anticholinergic Drug Scale, the Anticholinergic Risk Score, and the Anticholinergic Burden Scale. A logistic regression model was performed to study association of predictive variables with anticholinergic use. RESULTS: A high proportion of PD patients were prescribed anticholinergic drugs, with 53.6% of admissions receiving at least one drug from Duran et al.'s "low-risk" and 10% at least "high-risk" drug. Drugs used for non-motor symptoms and other comorbidities other than PD itself contributed significantly to anticholinergic burden, namely antidepressants, antipsychotics, urological drugs, analgesics, and antihistamines, among others. The total number of drugs and cholinesterase inhibitors were independently associated with anticholinergic drug use. CONCLUSIONS: Anticholinergic burden in PD patients is significant, and is caused mostly by drugs not used for PD motor symptoms. Polypharmacy and cholinesterase inhibitors were independently associated with anticholinergic drug prescriptions.
PURPOSE: Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients. METHOD: We analyzed information from different administrative Basque Country's healthcare databases using encrypted unique identifiers in order to detect PDpatients admitted to public acute care hospital during 2011-2012. Subsequently, anticholinergic burden was measured using Duran et al.'s list. Secondarily, total anticholinergic load was assessed with the Anticholinergic Drug Scale, the Anticholinergic Risk Score, and the Anticholinergic Burden Scale. A logistic regression model was performed to study association of predictive variables with anticholinergic use. RESULTS: A high proportion of PDpatients were prescribed anticholinergic drugs, with 53.6% of admissions receiving at least one drug from Duran et al.'s "low-risk" and 10% at least "high-risk" drug. Drugs used for non-motor symptoms and other comorbidities other than PD itself contributed significantly to anticholinergic burden, namely antidepressants, antipsychotics, urological drugs, analgesics, and antihistamines, among others. The total number of drugs and cholinesterase inhibitors were independently associated with anticholinergic drug use. CONCLUSIONS: Anticholinergic burden in PDpatients is significant, and is caused mostly by drugs not used for PD motor symptoms. Polypharmacy and cholinesterase inhibitors were independently associated with anticholinergic drug prescriptions.
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