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

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


Title: Anticholinergic medicines use among older adults before and after initiating dementia medicines
Author: Narayan, Sujita W.
Pearson, Sallie‐Anne
Litchfield, Melisa
Le Couteur, David G.
Buckley, Nicholas
McLachlan, Andrew J.
Zoega, Helga   orcid.org/0000-0003-0761-9028
Date: 2019-07-07
Language: English
Scope: 1957-1963
University/Institute: Háskóli Íslands
University of Iceland
School: Heilbrigðisvísindasvið (HÍ)
School of Health Sciences (UI)
Department: Læknadeild (HÍ)
Faculty of Medicine (UI)
Series: British Journal of Clinical Pharmacology;85(9)
ISSN: 0306-5251
1365-2125 (eISSN)
DOI: 10.1111/bcp.13976
Subject: Pharmacology; Anticholinergics; Australia; Cholinesterase inhibitors; Dementia; Older adults; Pharmacoepidemiology; Potentially inappropriate medicines; Lyfjafræði; Elliglöp; Aldraðir
URI: https://hdl.handle.net/20.500.11815/2046

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Citation:

Narayan, SW, Pearson, S‐A, Litchfield, M, et al. Anticholinergic medicines use among older adults before and after initiating dementia medicines. Br J Clin Pharmacol. 2019; 85: 1957– 1963. https://doi.org/10.1111/bcp.13976

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.

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This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

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