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

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...

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Autores principales: Narayan, Sujita W., Pearson, Sallie‐Anne, Litchfield, Melisa, Le Couteur, David G., Buckley, Nicholas, McLachlan, Andrew J., Zoega, Helga
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710547/
https://www.ncbi.nlm.nih.gov/pubmed/31046175
http://dx.doi.org/10.1111/bcp.13976
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author Narayan, Sujita W.
Pearson, Sallie‐Anne
Litchfield, Melisa
Le Couteur, David G.
Buckley, Nicholas
McLachlan, Andrew J.
Zoega, Helga
author_facet Narayan, Sujita W.
Pearson, Sallie‐Anne
Litchfield, Melisa
Le Couteur, David G.
Buckley, Nicholas
McLachlan, Andrew J.
Zoega, Helga
author_sort Narayan, Sujita W.
collection PubMed
description 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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spelling pubmed-67105472019-08-28 Anticholinergic medicines use among older adults before and after initiating dementia medicines Narayan, Sujita W. Pearson, Sallie‐Anne Litchfield, Melisa Le Couteur, David G. Buckley, Nicholas McLachlan, Andrew J. Zoega, Helga Br J Clin Pharmacol Original Articles 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. John Wiley and Sons Inc. 2019-07-07 2019-09 /pmc/articles/PMC6710547/ /pubmed/31046175 http://dx.doi.org/10.1111/bcp.13976 Text en © 2019 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ 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.
spellingShingle Original Articles
Narayan, Sujita W.
Pearson, Sallie‐Anne
Litchfield, Melisa
Le Couteur, David G.
Buckley, Nicholas
McLachlan, Andrew J.
Zoega, Helga
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
title_full Anticholinergic medicines use among older adults before and after initiating dementia medicines
title_fullStr Anticholinergic medicines use among older adults before and after initiating dementia medicines
title_full_unstemmed Anticholinergic medicines use among older adults before and after initiating dementia medicines
title_short Anticholinergic medicines use among older adults before and after initiating dementia medicines
title_sort anticholinergic medicines use among older adults before and after initiating dementia medicines
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710547/
https://www.ncbi.nlm.nih.gov/pubmed/31046175
http://dx.doi.org/10.1111/bcp.13976
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