Antimuscarinic Cascade Across Individual Cholinesterase Inhibitors in Older Adults with Dementia

Masurkar, P.; Chatterjee, Satabdi; Sherer, Jeffrey T.; Aparasu, Rajender R.

doi:10.1007/s40266-021-00863-5

Cited by 6 publications

(16 citation statements)

References 44 publications

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“…≥60; ≥65; ≥66 years) used across studies. 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 Thirteen studies reported analyses stratified by age. 7 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 Total study sample sizes ranged from 126 45 to 11 593 989 46 participants.…”

Section: Resultsmentioning

confidence: 99%

Prescribing cascades in community‐dwelling adults: A systematic review

Doherty¹,

Shahid

Moriarty³

et al. 2022

Pharmacology Res & Perspec

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The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community‐dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre‐registered with PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: community‐dwelling adults; risk‐prescription medication; outcomes‐initiation of new medicine to “treat” or reduce ADR risk; study type‐cohort, cross‐sectional, case‐control, and case‐series studies. Title/abstract screening, full‐text screening, data extraction, and methodological quality assessment were conducted independently in duplicate. A narrative synthesis was conducted. A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11 593 989 participants and 15 studies examined older adults specifically (≥60 years). Seventy‐eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic ( n = 5), amiodarone to levothyroxine ( n = 5), inhaled corticosteroid to topical antifungal ( n = 4), antipsychotic to anti‐Parkinson drug ( n = 4), and acetylcholinesterase inhibitor to urinary incontinence drugs ( n = 4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months.

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Section: Resultsmentioning

confidence: 99%

Prescribing cascades in community‐dwelling adults: A systematic review

Doherty¹,

Shahid

Moriarty³

et al. 2022

Pharmacology Res & Perspec

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“…107 The suspected ADRs, symptoms or new diagnoses explored were broad-ranging (see Table 2) most commonly depression (n=13) 33,37,40,45,52,55,57,73,95,99,100,112,114 ; peripheral oedema (n=11) [5][6][7]28,36,64,81,98,[105][106][107]118 ; urinary incontinence (n=9). 24,26,41,44,50,53,75,81,119 and parkinsonism (n=9) 27,29,31,46,57,81,84,123,124…”

Section: Suspected Adverse Reaction(s)mentioning

confidence: 99%

“…The most commonly identified prescribing cascades are summarised in Table 2. These include; amiodarone associated with subsequent thyroid hormone prescriptions for hypothyroidism (n=5), 54,61,87,89,125 CCBs associated with diuretic prescriptions to treat peripheral oedema (n=5), 5,7,89,106,107 topical antifungals to treat oral candidiasis following inhaled corticosteroids (n=4), 39,54,56,71 anti-Parkinson medication to treat Parkinsonian symptoms following antipsychotic initiation (n=4), 19,29,102,124 urinary anticholinergics to treat urinary incontinence following acetylcholinesterase inhibitors(n=4), 26,44,53,121 and antitussives to treat cough following angiotensin-converting enzyme inhibitors (ACEIs) (n=3). 18,74,89 Additional prescribing cascades identified included metoclopramide to anti-Parkinson medication (n=3).…”

Section: New Medication(s) Prescribedmentioning

confidence: 99%

“…]65 years) were more likely to receive; i) anticholinergics for urinary incontinence following SSRI initiation, 41 ii) ulcer drug therapy within 100 days of NSAID initiation, 91 iii) diuretic to treat betablocker induced oedema, 36 and, iv) thyroxine for hypothyroidism following amiodarone initiation. 87 Females were more likely to receive an antitussive for cough following ACEI initiation, 74 anticholinergic medication for urinary incontinence following acetylcholinesterase inhibitor 24,30 and SSRI initiation, 41 and levothyroxine following amiodarone initiation. 87 Differential associations were identified for initial medication dosage in nine studies.…”

Section: New Medication(s) Prescribedmentioning

confidence: 99%

“…Several studies reported stratified results by dosage, 5,7,28,29,39 concomitant medication use or polypharmacy, 7,40,44,87,106 duration, 32,96 comorbidity, 36,38,40,44 race 34 and nursing home residence. 26 For other studies, analyses were adjusted by age, 20,22,30,52,71,91,121 sex, 20,22,30,52,71,74,84,121 race, 22,121 dose, 52,71 nursing home residence, 22 concomitant medication or polypharmacy, 22,52,71 comorbidity, 121 with some studies conducting adjusted analyses but not reporting the independent association of these covariates. 23,27,31,90,119,120 Length of follow up ranged from one month 55,93,109,…”

Section: Introductionmentioning

confidence: 99%

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Prescribing cascades in community-dwelling adults: a systematic review

Doherty

Shahid

Cotter

et al. 2022

Preprint

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Background: The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. Methods: Systematic review reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline (Ovid), EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: Community-dwelling adults; Risk-prescription medication; Outcomes-initiation of new medicine to ‘treat’ or reduce ADR risk; Study type-cohort, cross-sectional, case-control and case-series studies. Title/abstract screening, full-text screening, data extraction and methodological quality assessment was conducted independently in duplicate. A narrative synthesis was conducted. Results: A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11,593,989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n=5), amiodarone to levothyroxine (n=5), inhaled corticosteroid to topical antifungal (n=4), antipsychotic to anti-Parkinson drug (n=4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n=4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Conclusion and implications: Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months. Word count: 245

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