Anticholinergic medicines use among older adults before and after initiating dementia medicines.

Abstract

AIMS:

We investigated anticholinergic medicines use among older adults initiating dementia medicines.

METHODS:

We used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days (n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines.

RESULTS:

One-third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3-3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6-12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3-9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines.

CONCLUSION:

Use of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.

• Authors: Sujita W Narayan, Sallie-Anne Pearson, Melisa Litchfield, David G Le Couteur, Nicholas Buckley, Andrew J McLachlan, Helga Zoega
• Journal: British journal of clinical pharmacology (Br J Clin Pharmacol) Vol. 85 Issue 9 Pg. 1957-1963 (09 2019) ISSN: 1365-2125 [Electronic] England
• PMID: 31046175 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

Chemical References

• Antipsychotic Agents
• Cholinergic Antagonists
• Cholinesterase Inhibitors
• Donepezil
• Risperidone
• Rivastigmine
• Memantine

Topics

• Aged
• Aged, 80 and over
• Antipsychotic Agents (therapeutic use)
• Australia
• Cholinergic Antagonists (therapeutic use)
• Cholinesterase Inhibitors (therapeutic use)
• Dementia (drug therapy)
• Deprescriptions
• Donepezil (therapeutic use)
• Drug Prescriptions (standards, statistics & numerical data)
• Female
• Humans
• Male
• Memantine (therapeutic use)
• Middle Aged
• Retrospective Studies
• Risperidone (therapeutic use)
• Rivastigmine (therapeutic use)