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Saraf U, Batla A, Sakakibara R, Panicker JN. The Impact of Polypharmacy on Management of Lower Urinary Tract Symptoms in Parkinson's Disease. Drugs Aging 2023; 40:909-917. [PMID: 37651023 DOI: 10.1007/s40266-023-01060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Lower urinary tract (LUT) symptoms are a common presentation of autonomic dysfunction in Parkinson's disease (PD). Symptoms significantly impact quality of life and are associated with worsening of motor symptoms and increased risk for falls. Different medical co-morbidities can often contribute to LUT symptoms, and a thorough evaluation therefore becomes essential. The effects of medications used for Parkinson's disease and other co-existing medical co-morbidities on LUT symptoms is often underestimated. Treatment options include behavioural therapy, oral agents such as antimuscarinic and beta-3 receptor agonist agents, botulinum toxin and neuromodulation. The first-line oral agents cause adverse effects that may exacerbate pre-existing Parkinson's disease-related symptoms. Furthermore, these oral agents can interact with other medications used in Parkinson's disease, and the challenges posed by interactions on pharmacological effects and metabolism are discussed. Knowledge about drug interactions can help in effective management of such patients and mitigate the risks for developing adverse effects.
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Affiliation(s)
- Udit Saraf
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Amit Batla
- Department of Clinical and Movement Neuroscience, Faculty of Brain Science, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
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Nawaz H, Sargent L, Quilon H, Cloud LJ, Testa CM, Snider JD, Lageman SK, Baron MS, Berman BD, Zimmerman K, Price ET, Mukhopadhyay ND, Barrett MJ. Anticholinergic Medication Burden in Parkinson's Disease Outpatients. JOURNAL OF PARKINSON'S DISEASE 2022; 12:599-606. [PMID: 34806617 DOI: 10.3233/jpd-212769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. OBJECTIVE To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. METHODS We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. RESULTS Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). CONCLUSION A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.
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Affiliation(s)
- Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.,Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Institute for Inclusion, Inquiry & Innovation (iCubed): Health & Wellness in Aging Populations Core, Richmond, VA, USA
| | | | - Leslie J Cloud
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Claudia M Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jon D Snider
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah K Lageman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark S Baron
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.,Southeast Veterans Affairs Parkinson's Disease Research, Education and Clinical Center (PADRECC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristin Zimmerman
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Elvin T Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Institute for Inclusion, Inquiry & Innovation (iCubed): Health & Wellness in Aging Populations Core, Richmond, VA, USA
| | - Nitai D Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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Barrett MJ, Sargent L, Nawaz H, Weintraub D, Price ET, Willis AW. Antimuscarinic Anticholinergic Medications in Parkinson Disease: To Prescribe or Deprescribe? Mov Disord Clin Pract 2021; 8:1181-1188. [PMID: 34765683 DOI: 10.1002/mdc3.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
The relative importance of antimuscarinic anticholinergic medications for Parkinson's disease (PD) declined after the introduction of levodopa, such that anticholinergic medications are now much more likely to be prescribed for clinical indications other than parkinsonism. Recent studies have found an association between anticholinergic medication exposure and future risk of dementia in older individuals and those with PD. These findings provide a further reason to avoid the use of anticholinergic medications to treat motor symptoms of PD. More importantly, they raise the question of whether one of the goals of PD treatment should be to deprescribe all medications with anticholinergic properties, regardless of their indication, to reduce dementia risk. In this review, we discuss the use of anticholinergic medications in PD, the evidence supporting the association between anticholinergic medications and future dementia risk, and the potential implications of these findings for clinical care in PD.
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Affiliation(s)
- Matthew J Barrett
- Department of Neurology Virginia Commonwealth University Richmond Virginia USA
| | - Lana Sargent
- School of Nursing Virginia Commonwealth University Richmond Virginia USA.,Department of Pharmacotherapy and Outcomes Science, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Geriatric Pharmacotherapy Program, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Institute for Inclusion Inquiry and Innovation (iCubed): Health and Wellness in Aging Populations Core Richmond Virginia USA
| | - Huma Nawaz
- Department of Neurology Virginia Commonwealth University Richmond Virginia USA
| | - Daniel Weintraub
- Department of Neurology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Parkinson's Disease Research, Education and Clinical Center Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA.,Department of Psychiatry University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
| | - Elvin T Price
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Geriatric Pharmacotherapy Program, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Institute for Inclusion Inquiry and Innovation (iCubed): Health and Wellness in Aging Populations Core Richmond Virginia USA
| | - Allison W Willis
- Department of Neurology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Center for Pharmacoepidemiology Research and Training, Department of Epidemiology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
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Valladales-Restrepo LF, Peña-Verjan NM, Vargas-Díaz K, Machado-Alba JE. Potentially inappropriate prescriptions of antipsychotic and anticholinergic drugs in patients with Parkinson's disease. Neurodegener Dis Manag 2021; 11:361-371. [PMID: 34525848 DOI: 10.2217/nmt-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The objective was to determine the prevalence of the potentially inappropriate antipsychotics and anticholinergics used in patients with Parkinson's disease. Materials & methods: A cross-sectional study identified the prescription of antipsychotics, anticholinergics and drugs for the treatment of Parkinson's disease. The anticholinergic burden was evaluated, and quetiapine and clozapine were considered to be adequate antipsychotics. Results: 2965 patients with Parkinson's disease were identified. The presence of psychiatric disorders and other neurological pathologies was associated with a greater probability of receiving potentially inappropriate antipsychotic prescriptions. The presence of greater number of comorbidities was associated with a greater probability of receiving anticholinergics. Conclusion: Older age and associated comorbidities, especially psychiatric and neurological comorbidities, increase the likelihood of patients with Parkinson's disease being prescribed antipsychotics and anticholinergics.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia.,Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Risaralda, Colombia
| | - Nathalia Marcela Peña-Verjan
- Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia
| | - Katherine Vargas-Díaz
- Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Risaralda, Colombia
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5
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Majali MA, Sunnaa M, Chand P. Emerging Pharmacotherapies for Motor Symptoms in Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:263-273. [PMID: 34219526 DOI: 10.1177/08919887211018275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) is the second commonest neurodegenerative disorder in the older adult and is characterized by progressive disabling motor symptoms of bradykinesia, tremor, rigidity, postural instability and also non motor symptoms that affect quality of life. The pharmacotherapy of PD consists of oral, transdermal, and subcutaneous medications, as well as invasive advanced therapies at later stages of the disease. PD medications are often started as monotherapy but with the progression of the illness often there is a need to add more medications and frequently comprises of a challenging polypharmacotherapy. Adverse effects of pharmacotherapy often add to the problems of adequate treatment. Patients and physicians have to prioritize treatment goals on the most disabling symptoms and the safest and most effective treatments. Almost every year newer medications and modes of delivery continue to be researched and added to the therapeutic armamentarium. This review article outlines existing and emerging pharmacotherapies for motor symptoms in PD.
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Affiliation(s)
- Mohammad Al Majali
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Michael Sunnaa
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Pratap Chand
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
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Rajan R, Saini A, Verma B, Choudhary N, Gupta A, Vishnu VY, Bhatia R, Singh MB, Srivastava AK, Srivastava MVP. Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease. Mov Disord Clin Pract 2020; 7:803-809. [PMID: 33043076 DOI: 10.1002/mdc3.13032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 ± 11.8 years and a duration of symptoms 6.3 ± 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; P < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, P = 0.007). Conclusion Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Arti Saini
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Bhawna Verma
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Nishu Choudhary
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Anu Gupta
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | | | - Rohit Bhatia
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Mamta B Singh
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Achal K Srivastava
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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7
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Bourrel C, Zacarin A, Rousseau V, Montastruc JL, Bagheri H. Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects? Fundam Clin Pharmacol 2020; 34:743-748. [PMID: 32289182 DOI: 10.1111/fcp.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 12/13/2022]
Abstract
The PAAPI project (Optimising Inappropriate Prescriptions in the Elderly) is a multi-disciplinary approach put in place by the Toulouse Pharmacovigilance Centre (CRPV) in order to improve drug prescribing practice in nursing homes. The aim of this study was to analyse the association between polypharmacy, frequency of prescriptions for potentially inappropriate medications (PIMs) and the anticholinergic burden of prescriptions in elderly patients from the PAAPI cohort. We carried out a retrospective study on residents of 24 nursing homes (EHPAD) participating in the PAAPI programme between 1er January 2017 and 31 December. Resident's Data were collected in a single review in a random day. Drug prescriptions were analysed quantitatively and qualitatively. PIMs and anticholinergic drugs were identified by the list EU(7)PIM and the Duran scale, respectively. The total anticholinergic burden was calculated by adding the anticholinergic scores of each drug. We classified the drugs into three categories: no anticholinergic burden (burden = 0), low anticholinergic burden (≥1 ≤ 3) or high anticholinergic burden (burden > 3). A total of 1191 residents living were included, and we analysed 8869 drug prescription lines. The average age of the residents was 87.0 ± 8.3 years, and the majority (71.5%) were female. Nearly half of the residents (49.6%, n = 67) having a prescription with a high anticholinergic burden were taking more than 9 drugs (Fisher exact test P < 0.05). All the prescriptions with more than 5 PIMs (n = 23) had an anticholinergic burden > 0, with the majority (65.2%, n = 15) having a high anticholinergic burden (Kruskal-Wallis test, P < 0.0001). In this cohort, 88% (n = 539) of prescriptions with a low anticholinergic burden and 100% (n = 135) of prescriptions with a high anticholinergic burden included at least one PIM. According to our study, the anticholinergic burden of prescriptions given to residents in the PAAPI cohort is associated with the prescription of PIMs and with polypharmacy. Optimizing the use of medicines remains essential in this population, given the harmful properties of these drugs. It would also be useful for the list of anticholinergic drugs to be updated as new medicines come onto the market.
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Affiliation(s)
- Claire Bourrel
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Alice Zacarin
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Jean-Louis Montastruc
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
| | - Haleh Bagheri
- Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France
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Liu YP, Chien WC, Chung CH, Chang HA, Kao YC, Tzeng NS. Are Anticholinergic Medications Associated With Increased Risk of Dementia and Behavioral and Psychological Symptoms of Dementia? A Nationwide 15-Year Follow-Up Cohort Study in Taiwan. Front Pharmacol 2020; 11:30. [PMID: 32116707 PMCID: PMC7033580 DOI: 10.3389/fphar.2020.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/OBJECTIVE In previous reports, the usage of anticholinergic medications has been associated with an increased risk of dementia with prolonged usage or with a high Anticholinergic Cognitive Burden (ACB). This study aimed to investigate the association between anticholinergic medications and the risk of dementia using data from Taiwan's National Health Research Database (NHIRD). METHODS A total of 790,240 patients, with 197,560 patients receiving anticholinergic medications and 592,680 control patients (1:3) matched for sex, age, and index-year, were enrolled from the two million Longitudinal Health Insurance Dataset, a subdataset of the NHIRD, between 2000 and 2015. The time-dependent Cox regression analysis was used to explore the hazard ratio (HR) with a 95% confidence interval for the association between anticholinergics and the risk of dementia during the 15-year follow-up. The behavioral and psychological symptoms of dementia (BPSD) were recognized by the usage of psychotropics. The ACB ranged from zero to three, divided as score <1, 1-1.9, 2-2.9, 3-4.9,and ≧5. The sensitivity analysis was done by excluding the diagnoses of dementia in the first 2 or 4 years after anticholinergic usage. RESULTS In the anticholinergic usage cohort, the HR was 1.043 (95% CI = 0.958-1.212, p = 0.139) without a significant difference. The sensitivity analysis revealed no association between the usage of anticholinergics and the risk of dementia. Anticholinergic usage was not associated with BPSD. Male sex, patients of ages of 60-64 and ≧80, usage of antiparkinsonian medications, a history of Parkinson's disease, epilepsy, urinary incontinence, depression, bipolar disorder, and psychotic disorder were independent risk factors of dementia. Increased HRs for dementia were associated with an ACB ≥ 5 and an anticholinergic usage period ≥ 1,460 days. CONCLUSION In this study, the usage of anticholinergics was not associated with the risk of dementia or BPSD in a 15-year follow-up study. However, patients with the male sex, patients with ages of 65-79 and ≧80, patients with some comorbidities, high ACB scores, and long anticholinergic treatment duration were associated with the risk of dementia.
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Affiliation(s)
- Yia-Ping Liu
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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Dubaz OM, Wu S, Cubillos F, Miao G, Simuni T. 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. Mov Disord Clin Pract 2019; 6:687-692. [PMID: 31745479 DOI: 10.1002/mdc3.12837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023] Open
Abstract
Background During the past decade, there has been increasing awareness of the side effects of dopamine agonists (DAs), including impulse control disorders. We hypothesized that there may be a shift toward more conservative use of DAs. Objective To explore the change in prescribing practices for dopaminergic medications in Parkinson's disease between 2010 and 2017. Methods Data were collected from the Parkinson's Foundation Quality Improvement Initiative registry. Baseline characteristics were compared between the 2010 and 2017 cohorts using chi-squared tests for discrete and t tests for continuous variables. Logistic regressions were conducted for each class of medications to assess the effect of time points (2010 vs. 2017) and prespecified covariates on the probability of prescribing. Results A total of 2,717 participants from 2010 and 2,900 participants from 2017 were included in the analysis. Mean (standard deviation) age was 67.4 (10) and 68.7 (9.3) for the 2010 and 2017 cohorts, respectively (P < 0.0001). After controlling for baseline characteristics, DA use was unchanged (P = 0.1172). The odds of using monoamine oxidase B inhibitors was 52% higher in 2017 than in 2010 (P < 0.0001), 38% lower for catechol-O-methyltransferase inhibitors (P < 0.0001), 25% lower for amantadine (P < 0.0001), and 31% lower for anticholinergics (P = 0.0153). There was no difference in the utilization of levodopa in the 2 cohorts (86.1% vs. 86.2%; P = 0.5783). Conclusions Despite increasing awareness of impulse control disorders, there has been no reduction in the use of DAs during the past decade. Overall, there is less utilization of adjunctive classes of drugs except for an increase in the use of monoamine oxidase B inhibitors.
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Affiliation(s)
- Ornella M Dubaz
- Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Samuel Wu
- Department of Biostatistics University of Florida Gainesville Florida USA
| | | | - Guanhong Miao
- Department of Biostatistics University of Florida Gainesville Florida USA
| | - Tanya Simuni
- Department of Neurology Northwestern University Chicago Illinois USA
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de Germay S, Rueter M, Montastruc F, Rousseau V, Lapeyre-Mestre M, Montastruc JL. Trends of atropinic (anticholinergic) exposure in the elderly: a 10-year analysis in the French EGB database. Fundam Clin Pharmacol 2019; 33:471-478. [PMID: 30687946 DOI: 10.1111/fcp.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
Atropinic drugs are known to potentially induce physical and/or mental impairments in the elderly. The aim of this study was to investigate trends of atropinic exposure in patients ≥65 years in France between 2006 and 2015. A repeated cross-sectional study was performed quarterly from January 1, 2006 to December 31, 2015, in the 'Echantillon Généraliste des Bénéficiaires (EGB)', a representative sample of the French population. Exposed patients were identified using the Anticholinergic Durán's list. Outcomes were rate of patients exposed to at least one atropinic drug (atropinic prevalence rate) and atropinic burden per patient (sum of atropinic burden scores). Interrupted time series were used to analyze the impact of market withdrawal of some drugs with atropinic properties during the period of the study. The number of patients ≥65 years registered in the EGB ranged from 75 611 in 2006 to 95 389 in 2015. Atropinic prevalence rate decreased significantly from 45.6% in 2006 to 33.2% in 2015 (-12.4%, slope significance P < 0.05). Subjects aged ≥85 years were the most exposed. Total atropinic burden decreased significantly between 2006 and 2015 (2.2 ± 1.7 in 2006; 2.0 ± 1.5 in 2015; slope significance P < 0.05), especially in patients ≥85 years. Market withdrawals for safety reasons of some atropinic drugs were significantly associated with a decrease in the atropinic prevalence rate (P < 0.05) and atropinic burden per patient (P < 0.05). In conclusion, atropinic drug exposure in the elderly significantly decreased in France between 2006 and 2015. This decrease can be partly explained by regulatory measures against some atropinic drugs.
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Affiliation(s)
- Sibylle de Germay
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Manuela Rueter
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre d'Evaluation et d'Information sur la PharmacoDépendance et d'AddictoVigilance (CEIP-A), 37 allées Jules Guesde, 31000, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
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11
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Benevent J, Hurault-Delarue C, Araujo M, Montastruc F, Montastruc JL, Lacroix I, Damase-Michel C. Higher intake of medications for digestive disorders in children prenatally exposed to drugs with atropinic properties. Fundam Clin Pharmacol 2018; 33:314-326. [PMID: 30365180 DOI: 10.1111/fcp.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022]
Abstract
Childhood digestive disorders are a common occurrence and are sometimes unexplained. Maternal medication during the development of the foetus' digestive system may contribute to the increase in childhood digestive disorders, especially with drugs acting on the cholinergic system. This study investigated the association between prenatal exposure to drugs with atropinic properties and the use of digestive disorder medications in childhood (0-3 years). Children from POMME (PrescriptiOn Médicaments Mères Enfants), a French database of reimbursed drugs for pregnant women and their children, were included (N = 8 372). Each drug prescribed during antenatal life was assigned an atropinic score (0 = null, 1 = low, 3 = strong). The prenatal atropinic burden was calculated as the sum of atropinic scores of drugs prescribed. More than 30% (N = 2 652) of the children were prenatally exposed to atropinic drugs. They used significantly more digestive disorder medications than unexposed children (RRa = 1.11 [1.06; 1.16]). The strength of the association increased with the prenatal atropinic burden. Our results suggest long-term digestive effects after prenatal exposure to atropinic drugs.
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Affiliation(s)
- Justine Benevent
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Caroline Hurault-Delarue
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Mélanie Araujo
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Isabelle Lacroix
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
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12
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Peyronnet B, Vurture G, Palma JA, Malacarne DR, Feigin A, Sussman RD, Biagioni MC, Palmerola R, Gilbert R, Rosenblum N, Frucht S, Kaufmann H, Nitti VW, Brucker BM. Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort. Parkinsonism Relat Disord 2018; 57:22-26. [PMID: 30037689 DOI: 10.1016/j.parkreldis.2018.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/15/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). METHODS A retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. RESULTS Fifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. CONCLUSION Mirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, New York University School of Medicine, New York, USA; Department of Urology, University of Rennes, Rennes, France.
| | - Gregory Vurture
- Department of Urology, New York University School of Medicine, New York, USA
| | - Jose-Alberto Palma
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | | | - Andrew Feigin
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Rachael D Sussman
- Department of Urology, New York University School of Medicine, New York, USA
| | - Milton C Biagioni
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Ricardo Palmerola
- Department of Urology, New York University School of Medicine, New York, USA
| | - Rebecca Gilbert
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Nirit Rosenblum
- Department of Urology, New York University School of Medicine, New York, USA
| | - Steven Frucht
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Horacio Kaufmann
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | - Victor W Nitti
- Department of Urology, New York University School of Medicine, New York, USA
| | - Benjamin M Brucker
- Department of Urology, New York University School of Medicine, New York, USA
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13
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de Germay S, Lapeyre-Mestre M, Montastruc JL, Montastruc F. [Atropinic burden and anticholinergic drugs: Interest and application in clinical practice in the elderly]. Therapie 2018; 76:665-673. [PMID: 29625707 DOI: 10.1016/j.therap.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
Abstract
Anticholinergic drugs (also called antimuscarinics or atropinics) increase the risk of falls, cognitive impairment and/or mortality in older patients. These drugs belong to the lists of potentially inappropriate medications in the elderly. The aim of this review was to present and discuss the different tools available to measure the atropinic risk in drug exposure of older patients. Several scales, developed from biological and/or clinical criteria, allow to classify anticholinergic drugs according to their atropinic potency and to assign to them an atropinic burden. Total atropinic burden of patient drug exposure can be calculated as the sum of atropinic score of each drug. Other tools include drug daily doses to better estimate the atropinic risk. These different methods are a precious help to decrease atropinic exposure in the elderly. Nevertheless, they have to be considered as upgradable and it is necessary to adapt them regularly according to the introduction of new drugs in clinical practice.
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Affiliation(s)
- Sibylle de Germay
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées d'évaluation et d'information sur la pharmacodépendance et d'addictovigilance (CEIP-A), centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
| | - François Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
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14
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Montastruc F, Benevent J, Touafchia A, Chebane L, Araujo M, Guitton-Bondon E, Durrieu G, Arbus C, Schmitt L, Begaud B, Montastruc JL. Atropinic (anticholinergic) burden in antipsychotic-treated patients. Fundam Clin Pharmacol 2017; 32:114-119. [DOI: 10.1111/fcp.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/01/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- François Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
- Département de Pharmacologie Médicale; INSERM U 1219 “Médicaments et Santé des Populations”; Université de Bordeaux; Bordeaux France
| | - Justine Benevent
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Anthony Touafchia
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Leila Chebane
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Mélanie Araujo
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Emmanuelle Guitton-Bondon
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Geneviève Durrieu
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Christophe Arbus
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Laurent Schmitt
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
| | - Bernard Begaud
- Département de Pharmacologie Médicale; INSERM U 1219 “Médicaments et Santé des Populations”; Université de Bordeaux; Bordeaux France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique; Centre Midi-Pyrénées de PharmacoVigilance; de Pharmacoépidémiologie et d'Informations sur le Médicament; Pharmacopôle Midi-Pyrénées; INSERM UMR 1027; CIC INSERM 1436; Faculté de Médecine de Toulouse; Centre Hospitalier Universitaire; Toulouse France
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15
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Perez-Lloret S, Peralta MC, Barrantes FJ. Pharmacotherapies for Parkinson's disease symptoms related to cholinergic degeneration. Expert Opin Pharmacother 2016; 17:2405-2415. [PMID: 27785919 DOI: 10.1080/14656566.2016.1254189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Dopamine depletion is one of the most important features of Parkinson's Disease (PD). However, insufficient response to dopaminergic replacement therapy suggests the involvement of other neurotransmitter systems in the pathophysiology of PD. Cholinergic degeneration contributes to gait impairments, cognitive impairment, psychosis, and REM-sleep disturbances, among other symptoms. Areas covered: In this review, we explore the idea that enhancing cholinergic tone by pharmacological or neurosurgical procedures could be a first-line therapeutic strategy for the treatment of symptoms derived from cholinergic degeneration in PD. Expert opinion: Rivastigmine, a drug that increases cholinergic tone by inhibiting the enzyme cholinesterase, is effective for dementia, whereas the use of Donepezil is still in the realm of investigation. Interesting results suggest the efficacy of these drugs in the treatment of gait dysfunction. Evidence on the clinical effects of these drugs for psychosis and REM-sleep disturbances is still weak. Stimulation of the pedunculo-pontine tegmental nuclei (which provide cholinergic innervation to the brain stem and subcortical nuclei) has also been used with some success for the treatment of gait dysfunction. Anticholinergic drugs should be used with caution in PD, as they may aggravate cholinergic symptoms. Notwithstanding, in some patients they might help control parkinsonian motor symptoms.
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Affiliation(s)
- Santiago Perez-Lloret
- a Institute of Cardiology Research , University of Buenos Aires, National Research Council (CONICET-ININCA) , Buenos Aires , Argentina
| | - María Cecilia Peralta
- b Parkinson's Disease and Movement Disorders Clinic, Neurology Department , CEMIC University Hospital , Buenos Aires , Argentina
| | - Francisco J Barrantes
- c Laboratory of Molecular Neurobiology , Institute for Biomedical Research, UCA-CONICET, Faculty of Medical Sciences , Buenos Aires , Argentina
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