Patient safety
Analysis of prescriptions in older adults in a Mental Health Outpatient Clinic at Vilardebó Hospital, Uruguay
Keywords:
PSYCHOTROPIC DRUGS, PHARMACOLOGY, DRUG PRESCRIPTIONS, ANTICHOLINERGIC LOAD
Abstract
Introduction: patients aged 65 years or older are at increased risk for exposure to adverse drug reactions because of their physiological status. Some risks are associated with the anticholinergic burden of medication, and others with the safety profile of each drug.
Objective: to perform an analysis of pharmacological treatments for patients aged 65 years old or older and their possible clinical implications, given the potential risks of adverse drug reactions.
Method: a descriptive, cross-sectional, observational, naturalistic, observational study of the pharmacological treatment of users aged 65 years old or older of the outpatient service at Vilardebó Hospital, between May and August 2021, was performed. A calculation was made of the anticholinergic burden of treatments and a comparison of this burden was made with a sample of patients under 65 years of age.
Results: 356 patients (83.0%) ≥ 65 years old were at high risk of having some kind of effect from their anticholinergic burden and this risk was similar to patients younger than 65 years. A total of 344 patients were in treatment with a benzodiazepine. The prescription of flunitrazepam (47.6%) and clonazepam (32.6%) stood out. While 289 patients (67.4%) were in treatment with an antipsychotic, 9 patients were on more than 2 antipsychotics. Two patients were on imipramine and 49 patients were in treatment with some antiparkinsonian drugs.
Conclusions: patients older than 65 years old are exposed to a high risk of suffering adverse drug reactions as a consequence of a high anticholinergic load (similar to that of the younger population studied) and a marked polypharmacy. In addition, some practices should be avoided, such as the prescription of certain types of benzodiazepines used in this population, as well as minimizing the use of imipramine and antiparkinsonian drugs. It is necessary to look for training strategies to minimize this potential risk that adversely affects the health of patients.
References
1) Armstrong KS, Temmingh H. Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: findings from a cross-sectional study in an upper-middle-income country. Braz J Psychiatr 2017; 39(4):293-301. doi: 10.1590/1516-4446-2016-2015.
2) Cotes RO, Goldsmith DR, Kopelovich SL, Lally CA, Druss BG. characteristics of medicaid recipients receiving persistent antipsychotic polypharmacy. Community Ment Health J 2018; 54(6):699-706. doi: 10.1007/s10597-017-0183-y.
3) Olmos I, Toledo M, Mato M, Giraldez G, Ricciardi C, Frontini M. Estudio de utilización de psicofármacos en usuarios de la policlínica del Hospital Vilardebó con diagnóstico de esquizofrenia (años 2006 y 2016). Rev Psiquiatr Urug 2021; 85(1):28-42.
4) Anathhanam S, Powis RA, Cracknell AL, Robson J. Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf 2012; 3(4):165-74. doi: 10.1177/2042098612443848.
5) Bates DW, Singh H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs (Millwood) 2018; 37(11):1736-43. doi: 10.1377/hlthaff.2018.0738.
6) Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008; 56(7):1333-41. doi: 10.1111/j.1532-5415.2008.01737.x.
7) Toto S, Hefner G, Hahn M, Hiemke C, Roll SC, Wolff J, et al. Current use of anticholinergic medications in a large naturalistic sample of psychiatric patients. J Neural Transm (Vienna) 2021; 128(2):263-72. doi: 10.1007/s00702-020-02298-5.
8) Back C, Wittmann M, Haen E. [Delirium induced by drug treatment]. Ther Umsch 2011; 68(1):27-33. doi: 10.1024/0040-5930/a000116.
9) Flacker JM, Cummings V, Mach JR, Bettin K, Kiely DK, Wei J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 1998; 6(1):31-41.
10) McEvoy JP. The clinical use of anticholinergic drugs as treatment for extrapyramidal side effects of neuroleptic drugs. J Clin Psychopharmacol 1983; 3(5):288-302.
11) Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000; 93(9):457-62. doi: 10.1177/014107680009300903.
12) Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 2015; 15:31. doi: 10.1186/s12877-015-0029-9.
13) Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med 2007; 167(8):781-7. doi: 10.1001/archinte.167.8.781.
14) Villalba-Moreno AM, Alfaro-Lara ER, Santos-Ramos B. Anticholinergic risk: use and limitations of anticholinergic scales. Eur J Intern Med 2015; 26(10):e65-6. doi: 10.1016/j.ejim.2015.08.014.
15) Kouladjian O’Donnell L, Gnjidic D, Nahas R, Bell JS, Hilmer SN. Anticholinergic burden: considerations for older adults. J Pharm Prac Res 2017; 47(1):67-77. doi: org/10.1002/jppr.1303.
16) Speranza N, Domínguez V, Pagano E, Artagaveytia P, Olmos I, Toledo M, et al. Consumo de benzodiazepinas en la población uruguaya: un posible problema de salud pública. Rev Méd Urug 2015; 31(2):112-9. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/213 [Consulta: 24 marzo 2022].
17) By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2015; 63(11):2227-46. doi: 10.1111/jgs.13702.
18) Danza Á, Rodríguez Branco M, López Pampín M, Agorio D, Caleri A, Patiño I, et al. Benzodiazepinas y fractura de cadera: estudio de casos y controles. Rev Méd Urug 2015; 31(2):120-7. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/214 [Consulta: 24 marzo 2022].
19) Bogunovic OJ, Greenfield SF. Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatr Serv 2004; 55(3):233-5. doi: 10.1176/appi.ps.55.3.233.
20) Maletta GJ. Use of benzodiazepines in elderly patients. May Clin Proc 1996; 71(11):1124. doi: 10.4065/71.11.1124.
21) Mato M, Toledo M, Olmos I, Frontini M, Nan F, Parpal L, et al. Estudio de consumo de benzodiacepinas en la policlínica del Hospital Vilardebó. Rev Psiquiatr Urug 2012; 76(1):25-34.
22) Uruguay. Universidad de la República. Facultad de Medicina. Recomendaciones para el uso de benzodiazepinas en Uruguay. Julio 2016. Disponible en: www.farmacologia.hc.edu.uy/images/Recomendaciones_uso_benzodiazepinas.pdf [Consulta: 31 mayo 2002].
23) Pratt N, Roughead EE, Ramsay E, Salter A, Ryan P. Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Saf 2011; 34(7):567-75. doi: 10.2165/11588470-000000000-00000.
24) Pringsheim T, Gardner DM. Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study. CMAJ Open 2014; 2(4):E225-32. doi: 10.9778/cmajo.20140009. eCollection 2014 Oct.
25) Tveito M, Handal M, Engedal K, Smith RL, Høiseth G, Skurtveit S. Prescribing of antipsychotic drugs to older patients living at home 2006–18. Tidsskr Nor Laegeforen 2019; 139(16). doi: 10.4045/tidsskr.19.0233.
26) Mato M, Olmos I, Toledo. Evolución del consumo de antipsicóticos en la Policlínica Psiquiátrica del Hospital Vilardebó. Rev Psiquiatr Urug 2017; 81(2):106-12.
27) Waal H, Vold JH, Skurtveit SO. Quetiapine abuse – myth or reality? Tidsskrift Nor Legeforen 2020; 140(12). doi: 0.4045/tidsskr.20.0059.
28) Tariot I, Ismail MS. Use of quetiapine in elderly patients. J Clin Psychiatry 2002; 63 Suppl 13:21-6.
29) El-Saifi N, Moyle W, Jones C, Tuffaha H. Quetiapine safety in older adults: a systematic literature review. J Clin Pharm Therap 2016; 41(1):7-18. doi: 10.1111/jcpt.12357.
30) Bernardo M, Rico-Villademoros F, García-Rizo C, Rojo R, Gómez-Huelgas R. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: a systematic review of population-based studies. Adv Ther 2021; 38(5):2491-2512. doi: 10.1007/s12325-021-01689-8.
31) Gallego JA, Nielsen J, De Hert M, Kane JM, Correll CU. Safety and tolerability of antipsychotic polypharmacy. Expert Opin Drug Saf 2012; 11(4):527-42. doi: 10.1517/14740338.2012.683523.
32) Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatr 2018;17(2):149-60. doi: 10.1002/wps.20516.
33) Roose SP, Schatzberg AF. The efficacy of antidepressants in the treatment of late-life depression. J Clin Psychopharmacol 2005; 25(4 Suppl 1):S1-7. doi: 10.1097/01.jcp.0000162807.84570.6b.
34) Pagano E, Domínguez V, Speranza N, Barboza L, Tamosiunas G. Evaluación del consumo en antidepresivos en la población uruguaya entre 2010 y 2014. Rev Méd Urug 2021; 37(3):e203. doi: 10.29193/RMU.37.3.3.
35) Sultana J, Spina E, Trifirò G. Antidepressant use in the elderly: the role of pharmacodynamics and pharmacokinetics in drug safety. Expert Opin Drug Metab Toxicol 2015; 11(6):883-92. doi: 10.1517/17425255.2015.1021684.
36) Jung YE, Jun TY, Kim KS, Bahk WM. Hyponatremia associated with selective serotonin reuptake inhibitors, mirtazapine, and venlafaxine in Korean patients with major depressive disorder. Int J Clin Pharmacol Ther 2011; 49(7):437-43. doi: 10.5414/cp201500.
37) Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging 2017; 12:1957-65. doi: 10.2147/CIA.S138535.
38) Sajadieh A, Binici Z, Mouridsen MR, Nielsen OW, Hansen JF, Haugaard SB. Mild hyponatremia carries a poor prognosis in community subjects. Am J Med 2009; 122(7):679-86. doi: 10.1016/j.amjmed.2008.11.033.
39) Weinrieb RM, Auriacombe M, Lynch KG, Lewis JD. Selective serotonin re-uptake inhibitors and the risk of bleeding. Expert Opin Drug Saf 2005; 4(2):337-44. doi: 10.1517/14740338.4.2.337.
40) Lenti MV, Pasina L, Cococcia S, et al. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Europ J Inter Med 2019; 61:54-61. doi: 10.1016/j.ejim.2018.11.003.
41) O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015; 44(2):213-8. doi: 10.1093/ageing/afu145.
42) Maldonado C, Vázquez M, Guevara N, Fagiolino P. Use of STOPP/ START criteria to perform active pharmacovigilance in the elderly. J Pharmacovigilance 2014 doi: 10.4172/2329-6887.1000146.
43) Cardwell K, Hughes CM, Ryan C. The Association between anticholinergic medication burden and health related outcomes in the “oldest old”: a systematic review of the literature. Drugs Aging 2015; 32(10):835-48. doi: 10.1007/s40266-015-0310-9.
44) Mayer T, Haefeli WE, Seidling HM. Different methods, different results—how do available methods link a patient’s anticholinergic load with adverse outcomes? Eur J Clin Pharmacol 2015; 71(11):1299-1314. doi: 10.1007/s00228-015-1932-x.
45) Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 2008. doi: 10.2217/1745509X.4.3.311.
46) Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 2015; 175(3):401-7. doi: 10.1001/jamainternmed.2014.7663.
47) Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc 2008; 56(12):2203-10. doi: 10.1111/j.1532-5415.2008.02009.x.
48) Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, et al. Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018; 361:k1315. doi: 10.1136/bmj.k1315.
49) Szabo SM, Gooch K, Schermer C, Walker D, Lozano-Ortega G, Rogula B, et al. Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study. BMJ Open 2019; 9(5):e026391. doi: 10.1136/bmjopen-2018-026391.
50) Naja M, Zmudka J, Hannat S, Liabeuf S, Serot JM, Jouanny P. In geriatric patients, delirium symptoms are related to the anticholinergic burden. Geriatr Gerontol Int 2016; 16(4):424-31. doi: 10.1111/ggi.12485.
51) Egberts A, Moreno-Gonzalez R, Alan H, Ziere G, Mattace-Raso FU. Anticholinergic drug burden and delirium: a systematic review. J Am Med Dir Assoc 2021; 22(1):65-73.e4. doi: 10.1016/j.jamda.2020.04.019.
52) Wilson MP, Pepper D, Currier GW, Holloman Jr GH, Feifel D. The psychopharmacology of agitation: consensus statement of the American Association for emergency psychiatry Project BETA psychopharmacology workgroup. West J Emerg Med 2012; 13(1):26-34. doi: 10.5811/westjem.2011.9.6866.
53) Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Ger Soc 2014; 62(10):1916-22. doi: 10.1111/jgs.13054.
54) Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: a systematic review and meta-analysis. Br J Clin Pharmacol 2015; 80(2):209-20. doi: 10.1111/bcp.12617.
55) Campbell NL, Perkins AJ, Bradt P, Perk S, Wielage RC, Boustani MA, et al. Association of anticholinergic burden with cognitive impairment and health care utilization among a diverse ambulatory older adult population. Pharmacotherapy 2016; 36(11):1123-31. doi: 10.1002/phar.1843.
56) Chatterjee S, Talwar A, Aparasu RR. Anticholinergic medications and risk of dementia in older adults: Where are we now? Expert Opin Drug Saf 2020; 19(10):1251-67. doi: 10.1080/14740338.2020.1811227.
57) Broder JC, Ryan J, Shah RC, Lockery JE, Orchard SG, Gilmartin-Thomas JF, et al. Anticholinergic medication burden and cognitive function in participants of the ASPREE study. Pharmacotherapy 2022; 42(2):134-44. doi: 10.1002/phar.2652.
58) Jessen F, Kaduszkiewicz H, Daerr M, Bickel H, Pentzek M, Riedel-Heller S, et al. Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 2010; 260 (Suppl 2):S111-5. doi: 10.1007/s00406-010-0156-4.
59) Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, Kopeček M, et al. European whites may need lower minimum therapeutic clozapine doses than those customarily proposed. J Clin Psychopharmacol 2021; 41(2):140-7. doi: 10.1097/JCP.0000000000001341.
60) Cetin M. Clozaphobia: fear of prescribers of Clozapine for treatment of schizophrenia. Bull Clin Psychopharmacol 2014; 24(4): 295-301. doi: 10.5455/bcp.20141223052008.
61) Toledo M, Olmos I, Ricciardi C. ¡Paradoja! La clozapina y su uso marginal. Rev Psiquiatr Urug 2018; 82(1):84-7.
62) de Leon J, Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, et al. An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels. Pharmacopsychiatry 2022; 55(2):73-86. doi: 10.1055/a-1625-6388.
63) Every-Palmer S, Inns SJ, Grant E, Ellis PM. Effects of clozapine on the gut: cross-sectional study of delayed gastric emptying and small and large intestinal dysmotility. CNS Drugs 2019; 33(1):81-91. doi: 10.1007/s40263-018-0587-4.
64) Every-Palmer S, Newton-Howes G, Clarke MJ. Pharmacological treatment for antipsychotic-related constipation. Cochrane Database Syst Rev 2017; 1(1):CD011128. doi: 10.1002/14651858.CD011128.pub2.
65) O’Mahony D, O’Leary P, Quigley EM. Aging and intestinal motility: a review of factors that affect intestinal motility in the aged. Drugs Aging 2002; 19(7):515-27. doi: 10.2165/00002512-200219070-00005.
66) Attard A, Iles A, Attard S, Atkinson N, Patel A. Clozapine: why wait to start a laxative? BJ Psych Adv 2019; 25:377-86. doi: 10.1192/bja.2019.42.
67) Koola MM. Anticholinergics to treat antipsychotic-induced extrapyramidal symptoms: time to avoid this practice. Asian J Psychiatr 2018; 31:100-1. doi: 10.1016/j.ajp.2018.01.009.
68) Dilsaver SC. Antimuscarinic agents as substances of abuse: a review. J Clin Psychophar 1988; 8(1):14-22. doi: 10.1097/00004714-198802000-00003.
2) Cotes RO, Goldsmith DR, Kopelovich SL, Lally CA, Druss BG. characteristics of medicaid recipients receiving persistent antipsychotic polypharmacy. Community Ment Health J 2018; 54(6):699-706. doi: 10.1007/s10597-017-0183-y.
3) Olmos I, Toledo M, Mato M, Giraldez G, Ricciardi C, Frontini M. Estudio de utilización de psicofármacos en usuarios de la policlínica del Hospital Vilardebó con diagnóstico de esquizofrenia (años 2006 y 2016). Rev Psiquiatr Urug 2021; 85(1):28-42.
4) Anathhanam S, Powis RA, Cracknell AL, Robson J. Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf 2012; 3(4):165-74. doi: 10.1177/2042098612443848.
5) Bates DW, Singh H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs (Millwood) 2018; 37(11):1736-43. doi: 10.1377/hlthaff.2018.0738.
6) Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008; 56(7):1333-41. doi: 10.1111/j.1532-5415.2008.01737.x.
7) Toto S, Hefner G, Hahn M, Hiemke C, Roll SC, Wolff J, et al. Current use of anticholinergic medications in a large naturalistic sample of psychiatric patients. J Neural Transm (Vienna) 2021; 128(2):263-72. doi: 10.1007/s00702-020-02298-5.
8) Back C, Wittmann M, Haen E. [Delirium induced by drug treatment]. Ther Umsch 2011; 68(1):27-33. doi: 10.1024/0040-5930/a000116.
9) Flacker JM, Cummings V, Mach JR, Bettin K, Kiely DK, Wei J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 1998; 6(1):31-41.
10) McEvoy JP. The clinical use of anticholinergic drugs as treatment for extrapyramidal side effects of neuroleptic drugs. J Clin Psychopharmacol 1983; 3(5):288-302.
11) Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000; 93(9):457-62. doi: 10.1177/014107680009300903.
12) Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 2015; 15:31. doi: 10.1186/s12877-015-0029-9.
13) Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med 2007; 167(8):781-7. doi: 10.1001/archinte.167.8.781.
14) Villalba-Moreno AM, Alfaro-Lara ER, Santos-Ramos B. Anticholinergic risk: use and limitations of anticholinergic scales. Eur J Intern Med 2015; 26(10):e65-6. doi: 10.1016/j.ejim.2015.08.014.
15) Kouladjian O’Donnell L, Gnjidic D, Nahas R, Bell JS, Hilmer SN. Anticholinergic burden: considerations for older adults. J Pharm Prac Res 2017; 47(1):67-77. doi: org/10.1002/jppr.1303.
16) Speranza N, Domínguez V, Pagano E, Artagaveytia P, Olmos I, Toledo M, et al. Consumo de benzodiazepinas en la población uruguaya: un posible problema de salud pública. Rev Méd Urug 2015; 31(2):112-9. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/213 [Consulta: 24 marzo 2022].
17) By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2015; 63(11):2227-46. doi: 10.1111/jgs.13702.
18) Danza Á, Rodríguez Branco M, López Pampín M, Agorio D, Caleri A, Patiño I, et al. Benzodiazepinas y fractura de cadera: estudio de casos y controles. Rev Méd Urug 2015; 31(2):120-7. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/214 [Consulta: 24 marzo 2022].
19) Bogunovic OJ, Greenfield SF. Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatr Serv 2004; 55(3):233-5. doi: 10.1176/appi.ps.55.3.233.
20) Maletta GJ. Use of benzodiazepines in elderly patients. May Clin Proc 1996; 71(11):1124. doi: 10.4065/71.11.1124.
21) Mato M, Toledo M, Olmos I, Frontini M, Nan F, Parpal L, et al. Estudio de consumo de benzodiacepinas en la policlínica del Hospital Vilardebó. Rev Psiquiatr Urug 2012; 76(1):25-34.
22) Uruguay. Universidad de la República. Facultad de Medicina. Recomendaciones para el uso de benzodiazepinas en Uruguay. Julio 2016. Disponible en: www.farmacologia.hc.edu.uy/images/Recomendaciones_uso_benzodiazepinas.pdf [Consulta: 31 mayo 2002].
23) Pratt N, Roughead EE, Ramsay E, Salter A, Ryan P. Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Saf 2011; 34(7):567-75. doi: 10.2165/11588470-000000000-00000.
24) Pringsheim T, Gardner DM. Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study. CMAJ Open 2014; 2(4):E225-32. doi: 10.9778/cmajo.20140009. eCollection 2014 Oct.
25) Tveito M, Handal M, Engedal K, Smith RL, Høiseth G, Skurtveit S. Prescribing of antipsychotic drugs to older patients living at home 2006–18. Tidsskr Nor Laegeforen 2019; 139(16). doi: 10.4045/tidsskr.19.0233.
26) Mato M, Olmos I, Toledo. Evolución del consumo de antipsicóticos en la Policlínica Psiquiátrica del Hospital Vilardebó. Rev Psiquiatr Urug 2017; 81(2):106-12.
27) Waal H, Vold JH, Skurtveit SO. Quetiapine abuse – myth or reality? Tidsskrift Nor Legeforen 2020; 140(12). doi: 0.4045/tidsskr.20.0059.
28) Tariot I, Ismail MS. Use of quetiapine in elderly patients. J Clin Psychiatry 2002; 63 Suppl 13:21-6.
29) El-Saifi N, Moyle W, Jones C, Tuffaha H. Quetiapine safety in older adults: a systematic literature review. J Clin Pharm Therap 2016; 41(1):7-18. doi: 10.1111/jcpt.12357.
30) Bernardo M, Rico-Villademoros F, García-Rizo C, Rojo R, Gómez-Huelgas R. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: a systematic review of population-based studies. Adv Ther 2021; 38(5):2491-2512. doi: 10.1007/s12325-021-01689-8.
31) Gallego JA, Nielsen J, De Hert M, Kane JM, Correll CU. Safety and tolerability of antipsychotic polypharmacy. Expert Opin Drug Saf 2012; 11(4):527-42. doi: 10.1517/14740338.2012.683523.
32) Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatr 2018;17(2):149-60. doi: 10.1002/wps.20516.
33) Roose SP, Schatzberg AF. The efficacy of antidepressants in the treatment of late-life depression. J Clin Psychopharmacol 2005; 25(4 Suppl 1):S1-7. doi: 10.1097/01.jcp.0000162807.84570.6b.
34) Pagano E, Domínguez V, Speranza N, Barboza L, Tamosiunas G. Evaluación del consumo en antidepresivos en la población uruguaya entre 2010 y 2014. Rev Méd Urug 2021; 37(3):e203. doi: 10.29193/RMU.37.3.3.
35) Sultana J, Spina E, Trifirò G. Antidepressant use in the elderly: the role of pharmacodynamics and pharmacokinetics in drug safety. Expert Opin Drug Metab Toxicol 2015; 11(6):883-92. doi: 10.1517/17425255.2015.1021684.
36) Jung YE, Jun TY, Kim KS, Bahk WM. Hyponatremia associated with selective serotonin reuptake inhibitors, mirtazapine, and venlafaxine in Korean patients with major depressive disorder. Int J Clin Pharmacol Ther 2011; 49(7):437-43. doi: 10.5414/cp201500.
37) Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging 2017; 12:1957-65. doi: 10.2147/CIA.S138535.
38) Sajadieh A, Binici Z, Mouridsen MR, Nielsen OW, Hansen JF, Haugaard SB. Mild hyponatremia carries a poor prognosis in community subjects. Am J Med 2009; 122(7):679-86. doi: 10.1016/j.amjmed.2008.11.033.
39) Weinrieb RM, Auriacombe M, Lynch KG, Lewis JD. Selective serotonin re-uptake inhibitors and the risk of bleeding. Expert Opin Drug Saf 2005; 4(2):337-44. doi: 10.1517/14740338.4.2.337.
40) Lenti MV, Pasina L, Cococcia S, et al. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Europ J Inter Med 2019; 61:54-61. doi: 10.1016/j.ejim.2018.11.003.
41) O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015; 44(2):213-8. doi: 10.1093/ageing/afu145.
42) Maldonado C, Vázquez M, Guevara N, Fagiolino P. Use of STOPP/ START criteria to perform active pharmacovigilance in the elderly. J Pharmacovigilance 2014 doi: 10.4172/2329-6887.1000146.
43) Cardwell K, Hughes CM, Ryan C. The Association between anticholinergic medication burden and health related outcomes in the “oldest old”: a systematic review of the literature. Drugs Aging 2015; 32(10):835-48. doi: 10.1007/s40266-015-0310-9.
44) Mayer T, Haefeli WE, Seidling HM. Different methods, different results—how do available methods link a patient’s anticholinergic load with adverse outcomes? Eur J Clin Pharmacol 2015; 71(11):1299-1314. doi: 10.1007/s00228-015-1932-x.
45) Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 2008. doi: 10.2217/1745509X.4.3.311.
46) Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 2015; 175(3):401-7. doi: 10.1001/jamainternmed.2014.7663.
47) Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc 2008; 56(12):2203-10. doi: 10.1111/j.1532-5415.2008.02009.x.
48) Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, et al. Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018; 361:k1315. doi: 10.1136/bmj.k1315.
49) Szabo SM, Gooch K, Schermer C, Walker D, Lozano-Ortega G, Rogula B, et al. Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study. BMJ Open 2019; 9(5):e026391. doi: 10.1136/bmjopen-2018-026391.
50) Naja M, Zmudka J, Hannat S, Liabeuf S, Serot JM, Jouanny P. In geriatric patients, delirium symptoms are related to the anticholinergic burden. Geriatr Gerontol Int 2016; 16(4):424-31. doi: 10.1111/ggi.12485.
51) Egberts A, Moreno-Gonzalez R, Alan H, Ziere G, Mattace-Raso FU. Anticholinergic drug burden and delirium: a systematic review. J Am Med Dir Assoc 2021; 22(1):65-73.e4. doi: 10.1016/j.jamda.2020.04.019.
52) Wilson MP, Pepper D, Currier GW, Holloman Jr GH, Feifel D. The psychopharmacology of agitation: consensus statement of the American Association for emergency psychiatry Project BETA psychopharmacology workgroup. West J Emerg Med 2012; 13(1):26-34. doi: 10.5811/westjem.2011.9.6866.
53) Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Ger Soc 2014; 62(10):1916-22. doi: 10.1111/jgs.13054.
54) Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: a systematic review and meta-analysis. Br J Clin Pharmacol 2015; 80(2):209-20. doi: 10.1111/bcp.12617.
55) Campbell NL, Perkins AJ, Bradt P, Perk S, Wielage RC, Boustani MA, et al. Association of anticholinergic burden with cognitive impairment and health care utilization among a diverse ambulatory older adult population. Pharmacotherapy 2016; 36(11):1123-31. doi: 10.1002/phar.1843.
56) Chatterjee S, Talwar A, Aparasu RR. Anticholinergic medications and risk of dementia in older adults: Where are we now? Expert Opin Drug Saf 2020; 19(10):1251-67. doi: 10.1080/14740338.2020.1811227.
57) Broder JC, Ryan J, Shah RC, Lockery JE, Orchard SG, Gilmartin-Thomas JF, et al. Anticholinergic medication burden and cognitive function in participants of the ASPREE study. Pharmacotherapy 2022; 42(2):134-44. doi: 10.1002/phar.2652.
58) Jessen F, Kaduszkiewicz H, Daerr M, Bickel H, Pentzek M, Riedel-Heller S, et al. Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 2010; 260 (Suppl 2):S111-5. doi: 10.1007/s00406-010-0156-4.
59) Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, Kopeček M, et al. European whites may need lower minimum therapeutic clozapine doses than those customarily proposed. J Clin Psychopharmacol 2021; 41(2):140-7. doi: 10.1097/JCP.0000000000001341.
60) Cetin M. Clozaphobia: fear of prescribers of Clozapine for treatment of schizophrenia. Bull Clin Psychopharmacol 2014; 24(4): 295-301. doi: 10.5455/bcp.20141223052008.
61) Toledo M, Olmos I, Ricciardi C. ¡Paradoja! La clozapina y su uso marginal. Rev Psiquiatr Urug 2018; 82(1):84-7.
62) de Leon J, Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, et al. An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels. Pharmacopsychiatry 2022; 55(2):73-86. doi: 10.1055/a-1625-6388.
63) Every-Palmer S, Inns SJ, Grant E, Ellis PM. Effects of clozapine on the gut: cross-sectional study of delayed gastric emptying and small and large intestinal dysmotility. CNS Drugs 2019; 33(1):81-91. doi: 10.1007/s40263-018-0587-4.
64) Every-Palmer S, Newton-Howes G, Clarke MJ. Pharmacological treatment for antipsychotic-related constipation. Cochrane Database Syst Rev 2017; 1(1):CD011128. doi: 10.1002/14651858.CD011128.pub2.
65) O’Mahony D, O’Leary P, Quigley EM. Aging and intestinal motility: a review of factors that affect intestinal motility in the aged. Drugs Aging 2002; 19(7):515-27. doi: 10.2165/00002512-200219070-00005.
66) Attard A, Iles A, Attard S, Atkinson N, Patel A. Clozapine: why wait to start a laxative? BJ Psych Adv 2019; 25:377-86. doi: 10.1192/bja.2019.42.
67) Koola MM. Anticholinergics to treat antipsychotic-induced extrapyramidal symptoms: time to avoid this practice. Asian J Psychiatr 2018; 31:100-1. doi: 10.1016/j.ajp.2018.01.009.
68) Dilsaver SC. Antimuscarinic agents as substances of abuse: a review. J Clin Psychophar 1988; 8(1):14-22. doi: 10.1097/00004714-198802000-00003.
Published
2022-12-12
How to Cite
1.
Olmos I, Angulo D, Mato M, Ricciardi C, Toledo M, Vázquez M. Patient safety. Rev. Méd. Urug. [Internet]. 2022Dec.12 [cited 2024Nov.25];38(4):e38404. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/980
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