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International Braz J Urol : Official... 2020
Topics: Case-Control Studies; Cholinergic Antagonists; Dementia; Humans
PubMed: 32022525
DOI: 10.1590/S1677-5538.IBJU.2020.02.10 -
Toxins Mar 2016In the present review, the main objective was to report the incidence and causes of herbal medicines induced anticholinergic poisoning in Hong Kong during 1989-2012 and... (Review)
Review
In the present review, the main objective was to report the incidence and causes of herbal medicines induced anticholinergic poisoning in Hong Kong during 1989-2012 and to emphasize the importance of pharmacovigilance, investigations and preventive measures. Relevant papers, official figures and unpublished data were obtained from Medline search, the Department of Health and the Drug and Poisons Information Bureau. In the New Territories East (where ~20% of the Hong Kong population lived), the incidence of herbal medicines induced anticholinergic poisoning during 1989-1993 was 0.09 per 100,000 population. There were no confirmed cases during 1994-1996. In the whole of Hong Kong, the incidence during 2000-June 2005 was 0.03 per 100,000 population. Contamination of Rhizoma Atractylodis (50%) and erroneous substitution (42%) were the main causes. The incidence during 2008-2012 was 0.06 per 100,000 population. Contamination of non-toxic herbs (50%) and erroneous substitution (41%) were the main causes. In Hong Kong, contamination of non-toxic herbs by tropane alkaloids and substitution of Flos Campsis by toxic Flos Daturae Metelis were the predominant causes of herbal medicines induced anticholinergic poisoning. Systematic studies along the supply chain are necessary to identify the likely sources of contamination. If erroneous substitution of Flos Campsis by Flos Daturae Metelis could be prevented, 40% of herbal medicines induced anticholinergic poisoning would not have occurred. Regular inspection of the retailer, continuing education for the staff in the herbal trade and repeated publicity measures will also be required. Pharmacovigilance of herbal medicines should help determine the incidence and causes of adverse reactions and monitor the effectiveness of preventive measures.
Topics: Cholinergic Antagonists; Hong Kong; Humans; Phytotherapy; Plants, Medicinal
PubMed: 26999208
DOI: 10.3390/toxins8030080 -
BMC Urology May 2023In this critical review, we explore the study design, strengths, and limitations of landmark trial "Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary... (Review)
Review
In this critical review, we explore the study design, strengths, and limitations of landmark trial "Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence". This trial was the first to directly compare two key treatment options for urge urinary incontinence - anticholinergic medication and intravesical botox, and still influences clinical guidelines a decade after publication. This non-inferiority, double-blinded, multi-centre randomised controlled trial administered Solifenacin or intra-detrusor botox to women, measuring outcomes six months post-treatment. Non-inferiority of the treatments was established, though Botox had a higher rate of retention and infection, with side effect profile rising as the key discriminator in selecting first-line therapy.
Topics: Female; Humans; Botulinum Toxins, Type A; Urology; Urinary Incontinence; Cholinergic Antagonists; Research Design; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37226116
DOI: 10.1186/s12894-023-01273-y -
Journal of General Internal Medicine Jun 2021Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking.
BACKGROUND
Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking.
OBJECTIVE
Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people.
DESIGN
Prospective cohort study.
SETTING
Primary care (Australia and USA).
PARTICIPANTS
19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) without major cardiovascular disease, dementia diagnosis, or Modified Mini-Mental State Examination score below 78/100.
MEASUREMENTS
Baseline anticholinergic exposure was calculated using the Anticholinergic Cognitive Burden (ACB) score. Dementia was adjudicated using Diagnostic and Statistical Manual of Mental Disorders volume IV criteria, and stroke using the World Health Organization definition.
RESULTS
At baseline, 15,000 participants (79%) had an ACB score of zero, 2930 (15%) a score of 1-2, and 1184 (6%) a score of ≥ 3 (indicating higher burden). After a median follow-up of 4.7 years and adjusting for baseline covariates, a baseline ACB score of ≥ 3 was associated with increased risk of ischemic stroke (adjusted HR 1.58, 95% CI 1.06, 2.35), or dementia (adjusted HR 1.36, 95% CI 1.01, 1.82), especially of mixed etiology (adjusted HR 1.53, 95% CI 1.06, 2.21). Results were similar for those exposed to moderate/highly anticholinergic medications.
LIMITATIONS
Residual confounding and reverse causality are possible. Assessment of dose or duration was not possible.
CONCLUSIONS
High anticholinergic burden in initially healthy older people was associated with increased risk of incident dementia and ischemic stroke. A vascular effect may underlie this association. These findings highlight the importance of minimizing anticholinergic exposure in healthy older people.
Topics: Aged; Australia; Cholinergic Antagonists; Cohort Studies; Dementia; Humans; Prospective Studies; Stroke
PubMed: 33754317
DOI: 10.1007/s11606-020-06550-2 -
Age and Ageing Sep 2023Anticholinergic medications block the neurotransmitter acetylcholine in the brain and peripheral nervous system. Many medications have anticholinergic properties, and... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Anticholinergic medications block the neurotransmitter acetylcholine in the brain and peripheral nervous system. Many medications have anticholinergic properties, and the cumulative effect of these medications is termed anticholinergic burden. Increased anticholinergic burden can have short-term side effects such as dry mouth, blurred vision and urinary retention as well as long-term effects including dementia, worsening physical function and falls.
METHODS
We carried out a systematic review (SR) with meta-analysis (MA) looking at randomised controlled trials addressing interventions to reduce anticholinergic burden in older adults.
RESULTS
We identified seven papers suitable for inclusion in our SR and MA. Interventions included multi-disciplinary involvement in medication reviews and deprescribing of AC medications. Pooled data revealed no significant difference in outcomes between control and intervention group for falls (OR = 0.76, 95% CI: 0.52-1.11, n = 647), cognition (mean difference = 1.54, 95% CI: -0.04 to 3.13, n = 405), anticholinergic burden (mean difference = 0.04, 95% CI: -0.11 to 0.18, n = 710) or quality of life (mean difference = 0.04, 95% CI: -0.04 to 0.12, n = 461).
DISCUSSION
Overall, there was no significant difference with interventions to reduce anticholinergic burden. As we did not see a significant change in anticholinergic burden scores following interventions, it is likely other outcomes would not change. Short follow-up time and lack of training and support surrounding successful deprescribing may have contributed.
Topics: Humans; Aged; Quality of Life; Cholinergic Antagonists; Acetylcholine; Brain; Cognition
PubMed: 37740900
DOI: 10.1093/ageing/afad176 -
Journal of the American Geriatrics... Oct 2015To evaluate concordance of five commonly used anticholinergic scales. (Comparative Study)
Comparative Study
OBJECTIVES
To evaluate concordance of five commonly used anticholinergic scales.
DESIGN
Cross-sectional secondary analysis.
SETTING
Pittsburgh, Pennsylvania, and Memphis, Tennessee.
PARTICIPANTS
Community-dwelling adults aged 70 to 79 with baseline medication data from the Health, Aging, and Body Composition Study (N = 3,055).
MEASUREMENTS
Any anticholinergic use, weighted scores, and total standardized daily dosage were calculated using five anticholinergic measures (Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Drug Burden Index anticholinergic component (DBI-ACh), and Summated Anticholinergic Medications Scale (SAMS)). Concordance was evaluated using kappa statistics and Spearman rank correlations.
RESULTS
Any anticholinergic use in rank order was 51% for the ACB, 43% for the ADS, 29% for the DBI-ACh, 23% for the ARS, and 16% for the SAMS. Kappa statistics for all pairwise use comparisons ranged from 0.33 to 0.68. Similarly, concordance as measured using weighted kappa statistics ranged from 0.54 to 0.70 for the three scales not incorporating dosage (ADS, ARS, ACB). Spearman rank correlation between the DBI-ACh and SAMS was 0.50.
CONCLUSION
Only low to moderate concordance was found between the five anticholinergic scales. Future research is needed to examine how these differences in measurement affect their predictive validity with respect to clinically relevant outcomes, such as cognitive impairment.
Topics: Aged; Cholinergic Antagonists; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Risk Assessment
PubMed: 26480974
DOI: 10.1111/jgs.13647 -
Drug Design, Development and Therapy 2018Penehyclidine hydrochloride (PHC) is an anticholinergic drug manufactured in China. It is used widely in clinics as a reversal agent in cases of organic phosphorus... (Review)
Review
BACKGROUND
Penehyclidine hydrochloride (PHC) is an anticholinergic drug manufactured in China. It is used widely in clinics as a reversal agent in cases of organic phosphorus poisoning and as a preanesthetic medication. Compared with other anticholinergic agents, PHC confers substantial advantages. Here, in this review, we focus on its important clinical effects for organic phosphorus poisoning, preanesthetic medication, and the protective effects on certain visceral organs.
MATERIALS AND METHODS
Our bibliographic sources include the PubMed and China National Knowledge Infrastructure (CNKI) databases, updated in March 2018. To assess the data in detail, we used the search terms "penehyclidine hydrochloride," "preanesthetic medication," and "organic phosphorus." Papers were restricted to those published in the English and Chinese languages, and to "paper" and "review" as the document type.
RESULTS
PHC can effectively antagonize the symptoms of central and peripheral poisoning caused by organophosphorus poisoning. As a preanesthetic medication, it can not only effectively reduce mucus secretion and vascular infiltration but can also relax airway smooth muscles, dilate bronchioles in pulmonary conditions such as bronchiectasis, and increase pulmonary dynamic compliance. It can also prevent reflexive actions of the vagus nerve caused by excessive acetylcholine release such as abnormal airway contraction. Furthermore, it can strengthen sedation, bidirectionally regulate heart rate, and effectively inhibit respiratory secretions. In recent studies, PHC was shown to also have protective effects on various organs, such as the heart, lungs, brain, kidneys, intestines, and liver.
CONCLUSION
PHC has beneficial pharmacological properties used in the treatment of organophosphorus poisoning and as a preanesthetic medication for its few side effects. It also has protective effects on multiple organs, suggesting that PHC has extensive clinical application value which is worth further research. This review should be of help to those intending to research these topics further.
Topics: Animals; Cholinergic Antagonists; Humans; Organophosphate Poisoning; Preanesthetic Medication; Quinuclidines
PubMed: 30323561
DOI: 10.2147/DDDT.S177435 -
Journal of Psychopharmacology (Oxford,... Jan 2021Dystonia is by far the most intrusive and invalidating extrapyramidal side effect of potent classical antipsychotic drugs. Antipsychotic drug-induced dystonia is... (Review)
Review
Dystonia is by far the most intrusive and invalidating extrapyramidal side effect of potent classical antipsychotic drugs. Antipsychotic drug-induced dystonia is classified in both acute and tardive forms. The incidence of drug-induced dystonia is associated with the affinity to inhibitory dopamine D2 receptors. Particularly acute dystonia can be treated with anticholinergic drugs, but the tardive form may also respond to such antimuscarinic treatment, which contrasts their effects in tardive dyskinesia. Combining knowledge of the pathophysiology of primary focal dystonia with the anatomical and pharmacological organization of the extrapyramidal system may shed some light on the mechanism of antipsychotic drug-induced dystonia. A suitable hypothesis is derived from the understanding that focal dystonia may be due to a faulty processing of somatosensory input, so leading to inappropriate execution of well-trained motor programmes. Neuroplastic alterations of the sensitivity of extrapyramidal medium-sized spiny projection neurons to stimulation, which are induced by the training of specific complex movements, lead to the sophisticated execution of these motor plans. The sudden and non-selective disinhibition of indirect pathway medium-sized spiny projection neurons by blocking dopamine D2 receptors may distort this process. Shutting down the widespread influence of tonically active giant cholinergic interneurons on all medium-sized spiny projection neurons by blocking muscarinic receptors may result in a reduction of the influence of extrapyramidal cortical-striatal-thalamic-cortical regulation. Furthermore, striatal cholinergic interneurons have an important role to play in integrating cerebellar input with the output of cerebral cortex, and are also targeted by dopaminergic nigrostriatal fibres affecting dopamine D2 receptors.
Topics: Antipsychotic Agents; Cholinergic Antagonists; Cholinergic Neurons; Dopamine D2 Receptor Antagonists; Dyskinesia, Drug-Induced; Dystonia; Extrapyramidal Tracts; Humans; Interneurons; Muscarinic Antagonists; Neuronal Plasticity; Receptors, Dopamine D2
PubMed: 32900259
DOI: 10.1177/0269881120944156 -
American Family Physician Sep 2019
Review
Topics: Administration, Cutaneous; Cholinergic Antagonists; Glycopyrrolate; Humans; Hyperhidrosis
PubMed: 31524358
DOI: No ID Found -
American Family Physician May 2016This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors... (Review)
Review
This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners.
Topics: Adrenergic alpha-Antagonists; Aftercare; Androgen Antagonists; Cholinergic Antagonists; Cystitis; Depression; Digital Rectal Examination; Gastrointestinal Hemorrhage; Healthy Lifestyle; Hematuria; Humans; Kallikreins; Male; Mass Screening; Neoplasm Recurrence, Local; Osteoporosis; Practice Guidelines as Topic; Primary Health Care; Proctitis; Prostate-Specific Antigen; Prostatic Neoplasms; Radiation Injuries; Rectum; Survivors; Urinary Incontinence
PubMed: 27175954
DOI: No ID Found