-
Pulmonary Pharmacology & Therapeutics 1998
Review
Topics: Animals; Cholinergic Antagonists; Humans; Receptors, Muscarinic; Respiratory Tract Diseases
PubMed: 10210656
DOI: No ID Found -
Pharmacotherapy Mar 2008Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH). The LUTS-BPH complex consists of both voiding and storage symptoms... (Review)
Review
Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH). The LUTS-BPH complex consists of both voiding and storage symptoms that may overlap with overactive bladder symptoms. Drug therapy for men with LUTS may include alpha1-antagonists, 5-alpha-reductase inhibitors, combination therapy, and over-the-counter phytotherapy. Anticholinergic agents are effective in relieving overactive bladder symptoms in patients without bladder outlet obstruction. However, anticholinergic therapy has historically been contraindicated in patients with LUTS associated with BPH because of concerns for developing acute urinary retention. To assess the safety and efficacy of anticholinergic therapies for LUTS associated with BPH, a MEDLINE search and a bibliographic search of the English-language literature were conducted. Two nonrandomized, open-label studies; two randomized trials that assessed anticholinergic therapy alone; and eight trials that assessed anticholinergic therapy in combination with an alpha1-antagonist were identified. Trials were of short duration (6-12 wks) and included only men with low postvoid residual volumes at baseline. Small nonsignificant changes were seen in objective measures of urinary function. Several trials demonstrated an increase in postvoid residual with anticholinergic therapy, which was statistically significant in two trials. Despite the increase in postvoid residual, rates of acute urinary retention were low and the drugs were well tolerated. Of the five trials that used a validated symptom scoring scale, two demonstrated subjective improvement in urinary function. Men with symptomatic overactive bladder and BPH who are not adequately relieved with alpha1-antagonists may benefit from the addition of an anticholinergic agent. Before starting therapy, however, a postvoid residual volume should be measured to measure to rule out baseline urinary retention.
Topics: Adrenergic alpha-1 Receptor Antagonists; Cholestenone 5 alpha-Reductase; Cholinergic Antagonists; Clinical Trials as Topic; Humans; Male; Prostatic Hyperplasia; Quality of Life; Urination Disorders
PubMed: 18294115
DOI: 10.1592/phco.28.3.356 -
Expert Opinion on Drug Safety Jun 2016Anticholinergics are a class of medicines that block the neurotransmitter, acetylcholine, in the brain and peripheral tissues. Medicines with anticholinergic activity... (Review)
Review
INTRODUCTION
Anticholinergics are a class of medicines that block the neurotransmitter, acetylcholine, in the brain and peripheral tissues. Medicines with anticholinergic activity are widely prescribed for and used by older people for various medical conditions. One-third to one-half of the medicines commonly prescribed for older people have anticholinergic activity. Several studies have reported anticholinergic burden to be a predictor of cognitive and functional impairments in older people.
AREAS COVERED
This article exemplifies the theoretical and clinical aspects of medicines with anticholinergic activity, including pharmacology (definition of medicines that possess anticholinergic activity, antimuscarinic receptors, therapeutic and adverse effects), epidemiology, measures and effects of cumulative anticholinergic burden in older adults, and clinical recommendations. In addition, the gaps in the literature have been identified for future research.
EXPERT OPINION
Many medicines that are commonly prescribed to older people have a degree of anticholinergic activity that can contribute to anticholinergic burden. Anticholinergic burden, measured in several ways that consider number, dose and/or degree of anticholinergic activity of medicines, has shown to be a predictor of adverse health and functional outcomes. The anticholinergic burden on older people should be minimised by avoiding, reducing dose and deprescribing medicines with anticholinergic activity where clinically possible.
Topics: Aged; Cholinergic Antagonists; Cognition Disorders; Dose-Response Relationship, Drug; Humans; Practice Patterns, Physicians'
PubMed: 26966981
DOI: 10.1517/14740338.2016.1165664 -
The American Journal of Geriatric... Dec 2016
Topics: Cholinergic Antagonists; Humans
PubMed: 27769834
DOI: 10.1016/j.jagp.2016.08.021 -
Archives of Gerontology and Geriatrics 2016Anticholinergic drugs may increase the risk of cognitive and functional disorders in older patients. There are anticholinergic scales on which said risk is estimated.... (Review)
Review
PURPOSE
Anticholinergic drugs may increase the risk of cognitive and functional disorders in older patients. There are anticholinergic scales on which said risk is estimated. The objectives of this study are: to identify the scales described in literature that are applicable to polypathological patients and analyze their clinical outcomes.
MATERIAL AND METHODS
A systematic review was performed. Data sources were MEDLINE, EMBASE and Web of Science which were consulted until August 2014.
INCLUSION CRITERIA
(1) studies that specify the list of drugs, describe the methodology for their elaboration and how they calibrate the anticholinergic potential and (2) studies that use the scales identified as a tool to measure exposure to anticholinergic drugs in polypathological patients or those with similar characteristics. The main differences between the scales and main results on cognitive, functional and mortality status were collected.
RESULTS
25 articles were included. 10 scales were identified. For their preparation, 8 were based on literature about drugs with anticholinergic activity and/or previously published scales as well as expert opinions. Exposure to anticholinergic drugs has been linked to cognitive disorders (basically measured with Anticholinergic Risk Scale (ARS), Anticholinergic Cognitive Burden Scale (ACB) and Drug Burden Index (DBI)) and functional scale (with ARS and DBI). However, there is no clear relationship with mortality. The Anticholinergic Drug Scale was the only one that obtained no association with any of the variables studied.
CONCLUSIONS
There is a great variety of scales published and applied to older patients. The clinical results are different depending on the scale used which is probably due to the different methodology in their elaboration.
Topics: Aged; Cholinergic Antagonists; Cognition; Cognition Disorders; Humans; Male; Risk; Risk Assessment
PubMed: 26518612
DOI: 10.1016/j.archger.2015.10.002 -
Expert Opinion on Drug Safety Sep 2010Anticholinergic agents are of noteworthy value in the treatment of chronic obstructive pulmonary disease (COPD), but concerns have been raised about a possible... (Review)
Review
IMPORTANCE OF THE FIELD
Anticholinergic agents are of noteworthy value in the treatment of chronic obstructive pulmonary disease (COPD), but concerns have been raised about a possible association between their use and cardiovascular (CV) morbidity and mortality. In this review, we have examined whether and why an anticholinergic agent, and in particular tiotropium, might cause CV risks.
AREAS COVERED IN THIS REVIEW
We first examine the potential pharmacological mechanisms that justify the CV risk with an anticholinergic agent, and then the main clinical trials, observational (cohort or case-control) studies, descriptive reviews and meta-analyses that have looked at the CV risks associated with long-term tiotropium, which are available in MEDLINE, EMBASE and Cochrane Controlled Trials Register databases, using the following MeSH, full text and keyword terms: tiotropium bromide OR Spiriva AND COPD OR chronic obstructive pulmonary disease.
WHAT THE READER WILL GAIN
The almost absolute confidence that there is no real increased risk for death or CV morbidity during treatment with this inhaled anticholinergic agent in patients with COPD because of the results of a large 4-year trial and a robust and extensive analysis of > 19,000 patients participating in placebo-controlled tiotropium clinical trials. Nonetheless, because high-risk patients such as those with coronary artery disease, heart failure, cardiac arrhythmia, hypoxemia requiring daytime oxygen therapy and a creatinine > 2 mg/dl were excluded from Phase III clinical trials, it is impossible to exclude these patients from an increased risk of drug-related cardiac events in a real-world setting.
TAKE HOME MESSAGE
Despite the recently raised concerns about an excess risk of CV adverse events with inhaled short-acting anticholinergic agents, the risk:benefit ratio of tiotropium bromide appears still favorable, although it is not known whether high-risk patients are at an increased risk of drug-related CV events.
Topics: Administration, Inhalation; Animals; Cardiovascular Diseases; Case-Control Studies; Cholinergic Antagonists; Clinical Trials as Topic; Cohort Studies; Comorbidity; Disease Susceptibility; Dogs; Heart; Humans; Meta-Analysis as Topic; Multicenter Studies as Topic; Parasympathetic Nervous System; Pulmonary Disease, Chronic Obstructive; Receptors, Muscarinic; Risk; Scopolamine Derivatives; Tiotropium Bromide
PubMed: 20565229
DOI: 10.1517/14740338.2010.500611 -
Expert Opinion on Drug Safety Sep 2011Many commonly used drugs have primary or secondary anticholinergic effects contributing to adverse outcomes ranging from mild-to-severe to potentially lethal.... (Review)
Review
INTRODUCTION
Many commonly used drugs have primary or secondary anticholinergic effects contributing to adverse outcomes ranging from mild-to-severe to potentially lethal. Anticholinergic adverse effects frequently occur with medications prescribed with other intended mechanisms of action, including antihistamines, antidepressants, and antipsychotics. Anticholinergic drugs are also the principal treatments of clinical conditions, such as urinary incontinence, that tend to occur in the elderly. Older patients and those with mental illness are particularly vulnerable to the adverse neuropsychiatric effects of anticholinergics as they may already have cognitive impairment.
AREAS COVERED
Medline and Pubmed literature searches (1966 - the present) were performed using 'anticholinergic' and 'drug safety'. Abstracts were assessed and references scanned for appropriate articles. Here, the authors i) describe the neural pathways of the cholinergic system; ii) outline the main clinical uses and adverse effects of anticholinergic agents with a focus on cognitive impairment; and iii) discuss anticholinergic safety monitoring.
EXPERT OPINION
Prescribers need to be vigilant for adverse anticholinergic effects, particularly in older patients. The symptoms may range from subtle cognitive impairment to delirium and may be due to the cumulative effect of multiple medications of modest antimuscarinic activity. The Anticholinergic Drug Scale and tables listing drugs with known anticholinergic properties may help in guiding clinical decision-making to reduce anticholinergic burden.
Topics: Cholinergic Antagonists; Cognition Disorders; Humans
PubMed: 21635190
DOI: 10.1517/14740338.2011.579899 -
The Cochrane Database of Systematic... 2004Anticholinergic agents such as ipratropium bromide are sometimes used in the treatment of chronic asthma. They effect bronchodilation and have also been used in... (Review)
Review
BACKGROUND
Anticholinergic agents such as ipratropium bromide are sometimes used in the treatment of chronic asthma. They effect bronchodilation and have also been used in combination with beta2-agonists in the management of chronic asthma.
OBJECTIVES
To examine the effectiveness of anticholinergic agents versus placebo and in comparison with beta2-agonists or as adjunctive therapy to beta2-agonists.
SEARCH STRATEGY
The Cochrane Airways Group asthma and wheeze database was searched with a pre-defined search strategy. Searches were current as of August 2003. Reference lists of articles were also examined.
SELECTION CRITERIA
Randomised trials or quasi-randomised trials were considered for inclusion. Studies assessing an anticholinergic agent versus placebo or in combination/comparison with beta2-agonists were included. In practice, all beta2-agonists were short acting. Short-term (less than 24 hours duration) and longer-term studies were separated; the latter are reported in this review and the former in the review, "Anticholinergic agents for chronic asthma in adults short term".
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed abstracts for retrieval of full text articles. Papers were then assessed for suitability for inclusion in the review. Data from included studies were extracted by two reviewers and entered into the software package (RevMan 4.2). We contacted authors for missing data and some responded. Adverse effect data were analysed if reported in the included studies.
MAIN RESULTS
The studies analysed were in two groups: those comparing anticholinergics with placebo and those comparing the combination of anticholinergics with short acting beta2-agonists versus short acting beta2-agonists alone. The former group had 13 studies involving 205 participants included in this review, and the latter 9 studies involving 440 patients. Generally methodological quality was poorly reported, and there were some reservations with respect to the quality of the studies. Despite the limited number of studies that could be combined, anticholinergic agents in comparison with placebo resulted in more favourable symptom scores particularly in respect of daytime dyspnoea (WMD -0.09 (95%CI -0.14, -0.04, 3 studies, 59 patients). Daily peak flow measurements also showed a statistically significant improvement for the anticholinergic (e.g. morning PEF: WMD =14.38 litres/min (95%CI 7.69, 21.08; 3 studies, 59 patients). However the clinical significance is small and in terms of peak flow measurements equates to approximately a 7% increase over placebo. The more clinically relevant comparison of a combination of anticholinergic plus short acting beta2-agonist versus short acting beta2-agonist alone gave no evidence in respect of symptom scores or peak flow rates of any significant differences between the two regimes. Again there are reservations with respect to the quality of the information from which these conclusions are drawn.
REVIEWERS' CONCLUSIONS
Overall this review provides no justification for routinely introducing anticholinergics as part of add-on treatment for patients whose asthma is not well controlled on standard therapies. This does not exclude the possibility that there may be a sub-group of patients who derive some benefit and a trial of treatment in individual patients may still be justified. The role of long term anticholinergics such as tiotropium bromide has yet to be established in patients with asthma and any future trials might draw on the messages derived from this review.
Topics: Adrenergic beta-Agonists; Adult; Asthma; Cholinergic Antagonists; Drug Therapy, Combination; Humans; Randomized Controlled Trials as Topic
PubMed: 15266477
DOI: 10.1002/14651858.CD003269.pub2 -
Drugs & Aging Mar 2014Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital... (Review)
Review
BACKGROUND
Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people.
OBJECTIVE
The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people.
DESIGN
A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures.
RESULTS
The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines.
CONCLUSIONS
The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.
Topics: Aged; Cholinergic Antagonists; Cognition; Cognition Disorders; Humans
PubMed: 24526293
DOI: 10.1007/s40266-014-0158-4 -
Brain and Nerve = Shinkei Kenkyu No... Apr 2016Elderly people are more likely than young people to develop cognitive impairments associated with medication use. One of the reasons for this is that renal and liver... (Review)
Review
Elderly people are more likely than young people to develop cognitive impairments associated with medication use. One of the reasons for this is that renal and liver functions are often impaired in elderly people. Dementia and delirium (an acute confused state) are known to be associated with drug toxicity. Anticholinergic medications are common causes of both acute and chronic cognitive impairment. Psychoactive drugs, antidepressants and anticonvulsants can cause dementia and delirium. In addition, non-psychoactive drugs such as histamine H2 receptor antagonists, corticosteroids, NSAIDs (nonsteroidal anti-inflammatory agent), and cardiac medications, may cause acute or chronic cognitive impairment. Early diagnosis and withdrawal of the offending agent are essential for the prevention of drug-induced dementia and delirium.
Topics: Animals; Antidepressive Agents; Cholinergic Antagonists; Cognition; Cognition Disorders; Delirium; Dementia; Humans
PubMed: 27056860
DOI: 10.11477/mf.1416200415