Association between Anticholinergic Burden and Constipation: A Systematic Review

Ramallo, H Rodríguez; Gutiérrez, N Báez; Mel, Elena Prado; Alfaro-Lara, Eva Rocío; Santos-Ramos, Bernardo; Sánchez-Fidalgo, Susana

doi:10.3390/healthcare9050581

Cited by 10 publications

(10 citation statements)

References 50 publications

(149 reference statements)

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“…The results of comparisons of combination antipsychotic therapy with monotherapy remain controversial. Combination antipsychotic therapy has shown little evidence of superior efficacy 28,29 and is associated with a cumulative risk of adverse effects, 30 pharmacokinetic interactions, mortality 31 and increased costs compared with monotherapy. 32 In the EGUIDE study of hospitalized patients in Japan, an analysis of the prescription rate from 2017 to 2019 showed a 90% SGA prescription rate and a 50% SGA monotherapy prescription rate.…”

Section: Discussionmentioning

confidence: 99%

Prescribing trends for the same patients with schizophrenia over 20 years

Yasuda

Kawamata

Sasaki

et al. 2022

Preprint

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BACKGROUND: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we decided to evaluate retrospectively schizophrenia patients with available data for 20 years to see whether the drug treatments in the same patients have changed in the past 20 years. METHODS: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (i.e., every 5 years). RESULTS: The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, decreasing, and flat trends over the past 20 years, respectively. CONCLUSION: The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

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Section: Discussionmentioning

confidence: 99%

Prescribing trends for the same patients with schizophrenia over 20 years

Yasuda

Kawamata

Sasaki

et al. 2022

Preprint

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“… 83 ) Anticholinergic drugs are the most important among the many drugs that cause constipation and should be prescribed as little as possible to older adults owing to their side effects; if needed, these drugs should be used with caution. 84 ) Magnesium oxide has been widely used as a laxative and is considered to be convenient, inexpensive, and relatively safe to administer. However, while prescribing magnesium oxide, optimal dosing, serum concentrations, drug–drug interactions, and potential side effects such as hypermagnesemia need to be considered; this is especially of consequence in older adults and in patients with renal impairment.…”

Section: Drug-related Functional Impairment In Rehabilitation Medicinementioning

confidence: 99%

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Yoshimura¹,

Matsumoto²,

Momosaki

2022

PRM

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Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

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“…Similar to other PD-related GI symptoms, the prevalence of constipation within the PD community is difficult to determine due to the varying diagnostic criteria and methods used to assess the symptom. Moreover, drugs used to control motor symptoms, particularly anticholinergics, can both cause and exacerbate constipation [63].…”

Section: Constipationmentioning

confidence: 99%

Gastrointestinal Dysfunction in Parkinson’s Disease: Current and Potential Therapeutics

Han

Finkelstein

McQuade

et al. 2022

JPM

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Abnormalities in the gastrointestinal (GI) tract of Parkinson’s disease (PD) sufferers were first reported over 200 years ago; however, the extent and role of GI dysfunction in PD disease progression is still unknown. GI dysfunctions, including dysphagia, gastroparesis, and constipation, are amongst the most prevalent non-motor symptoms in PD. These symptoms not only impact patient quality of life, but also complicate disease management. Conventional treatment pathways for GI dysfunctions (i.e., constipation), such as increasing fibre and fluid intake, and the use of over-the-counter laxatives, are generally ineffective in PD patients, and approved compounds such as guanylate cyclase C agonists and selective 5-hyroxytryptamine 4 receptor agonists have demonstrated limited efficacy. Thus, identification of potential targets for novel therapies to alleviate PD-induced GI dysfunctions are essential to improve clinical outcomes and quality of life in people with PD. Unlike the central nervous system (CNS), where PD pathology and the mechanisms involved in CNS damage are relatively well characterised, the effect of PD at the cellular and tissue level in the enteric nervous system (ENS) remains unclear, making it difficult to alleviate or reverse GI symptoms. However, the resurgence of interest in understanding how the GI tract is involved in various disease states, such as PD, has resulted in the identification of novel therapeutic avenues. This review focuses on common PD-related GI symptoms, and summarizes the current treatments available and their limitations. We propose that by targeting the intestinal barrier, ENS, and/or the gut microbiome, may prove successful in alleviating PD-related GI symptoms, and discuss emerging therapies and potential drugs that could be repurposed to target these areas.

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Association between Anticholinergic Burden and Constipation: A Systematic Review

Cited by 10 publications

References 50 publications

Prescribing trends for the same patients with schizophrenia over 20 years

Prescribing trends for the same patients with schizophrenia over 20 years

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Gastrointestinal Dysfunction in Parkinson’s Disease: Current and Potential Therapeutics

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