挪威抗胆碱能抗帕金森病药物的使用及潜在滥用情况：一项药物流行病学研究。
The use and potential abuse of anticholinergic antiparkinson drugs in Norway: a pharmacoepidemiological study.
作者信息
Gjerden Pål, Bramness Jørgen G, Slørdal Lars
机构信息
Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
出版信息
Br J Clin Pharmacol. 2009 Feb;67(2):228-33. doi: 10.1111/j.1365-2125.2008.03342.x. Epub 2008 Dec 16.
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
Anticholinergic antiparkinson drugs are used to ameliorate extrapyramidal symptoms caused by either Parkinson's disease or antipsychotic drugs, but their use in the treatment of Parkinson's disease is assumed to be in decline. Patients with psychotic conditions have a high prevalence of abuse of drugs, including anticholinergic antiparkinson drugs.
WHAT THIS STUDY ADDS
Anticholinergic antiparkinson drugs in Norway were primarily prescribed to patients using antipsychotic medication. The risk of abuse of this group of drugs was small, even among patients who probably abused other drugs.
AIMS
The use of anticholinergic antiparkinson drugs is assumed to have shifted from the therapy of Parkinson's disease to the amelioration of extrapyramidal adverse effects induced by antipsychotic drugs. There is a considerable body of data suggesting that anticholinergic antiparkinson drugs have a potential for abuse. The aim was to investigate the use and potential abuse of this class of drugs in Norway.
METHODS
Data were drawn from the Norwegian Prescription Database on sales to a total of 73 964 patients in 2004 of biperiden and orphenadrine, and use in patients with Parkinson's disease or in patients who were also prescribed antipsychotic agents. Possible abuse of these drugs was assessed by the level of use, skewedness of use, indications of drug-seeking behaviour and concomitant use of benzodiazepine tranquillizers, a group of prescription drugs with a recognized potential for abuse.
RESULTS
Anticholinergic antiparkinson drugs were prescribed to 4.5% of all outpatients who used antipsychotic drugs. This outnumbered sales to patients with Parkinson's disease by >20 to 1. We found indications of abuse of benzodiazepine tranquillizers among patients using antipsychotics, but there were no clear indications of abuse of anticholinergics, even among patients who were strongly suspected of abuse of benzodiazepines.
CONCLUSIONS
Anticholinergic antiparkinson drugs were used primarily by patients with psychotic illnesses. These patients have a very high prevalence of legal and illegal drug abuse, but the risk of abuse of anticholinergic antiparkinson drugs seemed small.
关于该主题已有的认知
抗胆碱能抗帕金森病药物用于改善帕金森病或抗精神病药物所致的锥体外系症状，但其在帕金森病治疗中的应用被认为呈下降趋势。患有精神疾病的患者滥用药物（包括抗胆碱能抗帕金森病药物）的比例很高。
本研究的新增内容
挪威的抗胆碱能抗帕金森病药物主要开给使用抗精神病药物的患者。即使在可能滥用其他药物的患者中，这类药物的滥用风险也很小。
目的
抗胆碱能抗帕金森病药物的使用被认为已从帕金森病治疗转向改善抗精神病药物所致的锥体外系不良反应。有大量数据表明抗胆碱能抗帕金森病药物有被滥用的可能性。目的是调查挪威这类药物的使用情况及潜在的滥用情况。
方法
数据取自挪威处方数据库，涉及2004年比哌立登和奥芬那君向总共73964名患者的销售情况，以及在帕金森病患者或同时开具了抗精神病药物的患者中的使用情况。通过使用水平、使用偏态、觅药行为迹象以及苯二氮䓬类镇静剂（一类公认有滥用可能性的处方药）的同时使用情况来评估这些药物可能的滥用情况。
结果
抗胆碱能抗帕金森病药物开给了4.5%使用抗精神病药物的门诊患者。这一数字比开给帕金森病患者的销量多出20倍以上。我们在使用抗精神病药物的患者中发现了滥用苯二氮䓬类镇静剂的迹象，但即使在强烈怀疑滥用苯二氮䓬类药物的患者中，也没有明显的抗胆碱能药物滥用迹象。
结论
抗胆碱能抗帕金森病药物主要由患有精神疾病的患者使用。这些患者合法和非法药物滥用的比例非常高，但抗胆碱能抗帕金森病药物的滥用风险似乎很小。
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