Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
J Am Geriatr Soc. 2014 Apr;62(4):690-5. doi: 10.1111/jgs.12741. Epub 2014 Mar 17.
To determine whether there is greater risk of initiation of oxybutynin to treat urinary incontinence (UI) after initiation of medicines reported to be associated with UI.
Prescription sequence symmetry analysis (PSSA).
Administrative claims data from the Australian Government Department of Veterans' Affairs.
Individuals who initiated oxybutynin and a medicine reported to be associated with UI in a 12-month period.
Between January 1, 2001, and December 31, 2011, the distribution of incident dispensing of medicines reported to be associated with UI (prazosin, diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), hormone replacement therapy (HRT), opioid analgesics, anticonvulsants, levodopa, antipsychotics, sedatives, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, anticholinesterases) was assessed before and after incident dispensing of oxybutynin (to treat UI). Crude and adjusted sequence ratios (ASRs) with 95% confidence intervals (CIs) were calculated.
Significant associations between initiation of CCBs, ACEIs, ARBs, and hypnotic-sedatives and subsequent initiation of oxybutynin were found. ASRs ranged from 1.28 (95% CI = 1.19-1.39) for ACEIs to 1.59 (95% CI = 1.29-1.96) for verapamil. In women, there was greater risk of initiation of oxybutynin after prazosin (ASR = 1.84, 95% CI = 1.29-2.63) and HRT (ASR = 1.54, 95% CI = 1.42-1.67) initiation. PSSA showed no significant association with initiation of opioids, anticonvulsants, levodopa, SSRIs, venlafaxine, or anticholinesterases and subsequent initiation of oxybutynin.
This study highlights the potential for initiation of commonly used medicines to be associated with subsequent initiation of oxybutynin to treat UI. Greater awareness of the potential for medicines to contribute to UI is required.
确定在开始使用报告与尿失禁（UI）相关的药物后，使用奥昔布宁开始治疗 UI 的风险是否更大。
处方序列对称分析（PSSA）。
澳大利亚退伍军人事务部的行政索赔数据。
在 12 个月内开始使用奥昔布宁和一种报告与 UI 相关的药物的个体。
在 2001 年 1 月 1 日至 2011 年 12 月 31 日期间，评估了报告与 UI 相关的药物（哌唑嗪、利尿剂、钙通道阻滞剂（CCBs）、血管紧张素转换酶抑制剂（ACEIs）、血管紧张素受体阻滞剂（ARBs）、激素替代疗法（HRT）、阿片类镇痛药、抗惊厥药、左旋多巴、抗精神病药、镇静剂、选择性 5-羟色胺再摄取抑制剂（SSRIs）、文拉法辛、抗胆碱酯酶）的起始分布情况）在开始使用奥昔布宁（治疗 UI）之前和之后。计算了粗序列比（ASR）和 95%置信区间（CI）。
发现 CCBs、ACEIs、ARBs 和催眠镇静剂的起始与随后奥昔布宁的起始之间存在显著关联。ASR 范围从 ACEIs 的 1.28（95%CI=1.19-1.39）到维拉帕米的 1.59（95%CI=1.29-1.96）。在女性中，与哌唑嗪（ASR=1.84，95%CI=1.29-2.63）和 HRT（ASR=1.54，95%CI=1.42-1.67）起始相比，奥昔布宁起始的风险更高。PSSA 与阿片类药物、抗惊厥药、左旋多巴、SSRIs、文拉法辛或抗胆碱酯酶的起始与随后奥昔布宁的起始之间没有显著关联。
本研究强调了常用药物的起始可能与随后开始使用奥昔布宁治疗 UI 有关。需要进一步提高对药物可能导致 UI 的认识。
