and the results are expressed as means± SD for continuous variables and as percentages (%) for categorical variables. Results 71 patients (53.3% women, mean age 82.7±6.7 (58-94) years) were treated with an AChEI. 74.6% (53 patients) were simultaneously treated with a DAP. Mean concomitant prescribed drugs (DAP and non-DAP) was 11.6±4.7 drugs (2-26). Prescribed AChEI were rivastigmine 56.3%, donepezil 38% and galantamine 5.6%. According to the classification of the systematic review of Durán et al, 71 patients were treated with a total of 95 DAP. The seven most frequently prescribed anticholinergic drugs were: quetiapine 39.4%, haloperidol 22.5%, ipratropium 21.1%, trazodone 14.1%, risperidone 12.7%, mirtazapine 7% and tramadol 5.6%. 57.7% of patients had dementia symptoms: confusional syndrome 31%, cognitive impairment 28.2%, mood disturbances 12.9% and somnolence 9.9%. The main destination was hospitalisation 85.9%, followed by hospital discharge 11.3% and death 2.8%. Conclusion and relevance A high percentage of elderly patients with dementia treated with AChEI were taking concomitant DAP, that present accumulated risk. The combined use of these drugs can increase cognitive impairment and also antagonise the effects of AChEI. The results of the study suggest the need for considering other treatment options or a decrease in the prescriptions for DAPs to reduce the pharmacological interactions and the related adverse effects of concomitant use.
Background: Screening approved medications to identify therapeutics for drug repurposing is an effective tactic, and a deep research into off label drug use (OLDU) is required. Unfortunately, OLDU has not been extensively studied in Middle East. Our study aimed to evaluate the extent of OLDU in Saudi Arabia.Methods: Retrospective study carried out during 12 month period at six tertiary hospitals in Saudi Arabia. Each prescription was evaluated as unlicensed or OLDU based on the product information or based on Food and drug Administration (FDA) approval.Results: A total of 288 prescriptions were analyzed, where the reasons for off-label prescribing were OLDU by indication (94.42%), OLDU by different age group (2.09%), and other reasons represented (3.48%). Adults/geriatrics (≥18 years) received (89.05%) of the orders, and children (1-11 years) received (7.78%) of the orders. Both adolescents (12-18 years) and neonates (1-29 days) received (1.42%) of the orders per each category, while infants (1 month-1 year) received (0.36%) of the orders. The therapeutic classes most often prescribed were antidepressants (21.88%), antidiabetics (17.71%), and atypical antipsychotics (10.06%).Conclusions: Off-label prescribing was found in most adults/geriatrics suffering from depression, and diabetes mellitus. The most common reason for off-label prescription was off-label by indication. The results call for the need to conduct more studies with larger sample size, do more investigations on the OLDU in the whole kingdom, and develop policy for OLDU across hospitals.
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