Anticholinergic burden in Parkinson’s disease inpatients

Lertxundi, Unax; Isla, Arantxazu; Solinís, Maria Ángelés; Domingo-Echaburu, Saioa; Hernández, Rafael; Peral-Aguirregoitia, Javier; Medrano, Juan

doi:10.1007/s00228-015-1919-7

Cited by 27 publications

(22 citation statements)

References 23 publications

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“…Because use of atropinic drugs in PD is currently debated, it is clinically relevant to investigate the atropinic burden of all prescriptions in such patients and its clinical importance. The 2 sole available studies (the present data and Lertxundi's work) clearly indicate that atropinic drugs are still widely prescribed in PD. In our investigation, these drugs were found in almost 3 of 5 prescription forms, and more than 1 PD patient of 5 received more than 1 atropinic drug (with a maximum of 5 different atropinics).…”

Section: Discussion and Clinical Consequencessupporting

confidence: 58%

“…The most used drugs were trihexiphenidyle and oxybutynin, prescribed as an antiparkinsonian and for the urinary tract, respectively. This point was not discussed by Lertxundi's …”

Section: Discussion and Clinical Consequencesmentioning

confidence: 91%

“…The Yarnall's group investigated anticholinergic (atropinic) load in 219 patients with early PD versus 99 controls using the ADS and found more atropinic drugs prescribed in PD than in controls without any difference in cognitive scores. Using Duran's list, Lertxundi et al, investigating 1628 inpatients with PD in 2011‐2012 in 11 public acute‐care hospitals in the Basque country, found that 53.6% of patients received at least 1 atropinic drug with 10% of “high‐risk” drugs. Drugs for nonmotor symptoms (antidepressant, antipsychotic, H1 antihistamine, urological, and analgesic drugs) contributed significantly to atropinic burden.…”

Section: Atropinic Risk Scalesmentioning

confidence: 99%

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Atropinic (Anticholinergic) Burden in Parkinson's Disease

et al. 2016

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Use of atropinic drugs remains controversial in Parkinson's disease (PD) because there is insufficient evidence about their efficacy and they can induce serious adverse drug reactions. Atropinic risk scales were developed to help to identify atropinic drugs in prescription forms and to evaluate their burden in clinical practice. In the present review, we discuss the few studies investigating atropinic burden in PD and present the results of our study indicating that atropinic drugs are still widely prescribed in PD (almost 3 of 5 prescriptions) with a clinically significant atropinic burden in around 1 of 6 PD patients. Drugs mainly responsible for high values of atropinic burden were those used for nonmotor symptoms. Clinically significant atropinic burdens were mainly induced by associations of several "low-risk" drugs. Physicians must be aware that in addition to classical atropinic antiparkinsonian drugs, many others (psychotropics) can contribute to increased atropinic burden in PD patients. © 2016 International Parkinson and Movement Disorder Society.

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Section: Discussion and Clinical Consequencessupporting

confidence: 58%

“…The most used drugs were trihexiphenidyle and oxybutynin, prescribed as an antiparkinsonian and for the urinary tract, respectively. This point was not discussed by Lertxundi's …”

Section: Discussion and Clinical Consequencesmentioning

confidence: 91%

Section: Atropinic Risk Scalesmentioning

confidence: 99%

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Atropinic (Anticholinergic) Burden in Parkinson's Disease

et al. 2016

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“…Diverse dopaminergic and nondopaminergic pharmacological approaches have been developed to manage such complications, including novel l -DOPA formulations, COMT inhibitors (opicapone), dopamine agonists, adenosine A2A antagonists (istradefylline, preladenant, tozadenant), glutamatergic N -methyl- d -aspartate (NMDA) antagonists, serotonergic agents (eltoprazine), and metabotropic glutamate receptor 5 (mGluR5) modulators (mavoglurant), with controversial results [82,83]. Polypharmacy with antidepressants, antipsychotics, urological drugs, analgesics, antihistaminics and cholinesterase inhibitors also contributes to severe complications associated with the anticholinergic burden in PD [84]. Furthermore, gastrointestinal complications (constipation, sialorrhea, dysphagia, difficulty in mastication, choking/aspiration) [85,86], cardiovascular problems [87,88], neuroendocrine changes and psychiatric disorders are frequent in PD patients chronically treated with conventional antiparkinsonian drugs [9,85].…”

Section: Conventional Treatmentsmentioning

confidence: 99%

Parkinson’s Disease: From Pathogenesis to Pharmacogenomics

Cacabelos

2017

IJMS

431

300

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Parkinson’s disease (PD) is the second most important age-related neurodegenerative disorder in developed societies, after Alzheimer’s disease, with a prevalence ranging from 41 per 100,000 in the fourth decade of life to over 1900 per 100,000 in people over 80 years of age. As a movement disorder, the PD phenotype is characterized by rigidity, resting tremor, and bradykinesia. Parkinson’s disease -related neurodegeneration is likely to occur several decades before the onset of the motor symptoms. Potential risk factors include environmental toxins, drugs, pesticides, brain microtrauma, focal cerebrovascular damage, and genomic defects. Parkinson’s disease neuropathology is characterized by a selective loss of dopaminergic neurons in the substantia nigra pars compacta, with widespread involvement of other central nervous system (CNS) structures and peripheral tissues. Pathogenic mechanisms associated with genomic, epigenetic and environmental factors lead to conformational changes and deposits of key proteins due to abnormalities in the ubiquitin–proteasome system together with dysregulation of mitochondrial function and oxidative stress. Conventional pharmacological treatments for PD are dopamine precursors (levodopa, l-DOPA, l-3,4 dihidroxifenilalanina), and other symptomatic treatments including dopamine agonists (amantadine, apomorphine, bromocriptine, cabergoline, lisuride, pergolide, pramipexole, ropinirole, rotigotine), monoamine oxidase (MAO) inhibitors (selegiline, rasagiline), and catechol-O-methyltransferase (COMT) inhibitors (entacapone, tolcapone). The chronic administration of antiparkinsonian drugs currently induces the “wearing-off phenomenon”, with additional psychomotor and autonomic complications. In order to minimize these clinical complications, novel compounds have been developed. Novel drugs and bioproducts for the treatment of PD should address dopaminergic neuroprotection to reduce premature neurodegeneration in addition to enhancing dopaminergic neurotransmission. Since biochemical changes and therapeutic outcomes are highly dependent upon the genomic profiles of PD patients, personalized treatments should rely on pharmacogenetic procedures to optimize therapeutics.

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“…The initial complication of long-term L-DOPA therapy is the "wearing-off" phenomenon [17,18], together with motor fluctuations and dyskinesia, which develop during the use of both L-DOPA and dopamine agonists [14,[19][20][21]. Polypharmacy with antidepressants, antipsychotics, urological drugs, analgesics, antihistaminics and cholinesterase inhibitors also contributes to severe complications associated with the anticholinergic burden in PD [22]. Furthermore, gastrointestinal complications (constipation, sialorrhea, dysphagia, difficulty in mastication, choking/aspiration) [23], cardiovascular problems [24], neuroendocrine changes and psychiatric disorders are frequent in Parkinsonian patients chronically treated with conventional antiparkinsonian drugs [16,23].…”

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confidence: 99%