Montastruc François, Benevent Justine, Touafchia Anthony, Chebane Leila, Araujo Mélanie, Guitton-Bondon Emmanuelle, Durrieu Geneviève, Arbus Christophe, Schmitt Laurent, Begaud Bernard, Montastruc Jean-Louis
Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, INSERM UMR 1027, CIC INSERM 1436, Faculté de Médecine de Toulouse, Centre Hospitalier Universitaire, Toulouse, France.
Département de Pharmacologie Médicale, INSERM U 1219 "Médicaments et Santé des Populations", Université de Bordeaux, Bordeaux, France.
Fundam Clin Pharmacol. 2018 Feb;32(1):114-119. doi: 10.1111/fcp.12321. Epub 2017 Sep 27.
Antipsychotic drugs possess side atropinic (anticholinergic) properties that may induce several adverse drug reactions (ADRs), such as memory loss or cognitive impairment. The aim of this study was to investigate anticholinergic burden in patients treated with antipsychotic drugs. All ADR reports including at least one antipsychotic and registered between 2000 and 2015 in the Midi-Pyrénées PharmacoVigilance Database were extracted and analyzed using the Anticholinergic Duran's list. The primary objective of this cross-sectional study was to calculate anticholinergic burden in antipsychotic-treated patients; the secondary one was to investigate associated factors. Among the 1948 reports, the average number of atropinic drugs per report was 2.4 ± 1.4. At least one atropinic drug was found in 59.4% of reports (1158), in addition to antipsychotic drugs. The mean anticholinergic burden per report was 3.9 ± 2.9. A value ≥3 was found in 61.7% of the reports. A significant association between anticholinergic burden, age, and male gender of patients was found. The mean value of anticholinergic burden remained stable during the study period. This study showed high values of anticholinergic burden in patients receiving antipsychotics. Thus, considering the potential noxious clinical impact of atropinic properties on cognitive functions, an appropriate approach should be used to reduce prescription of antipsychotics with a high anticholinergic burden but also coprescription of other frequently associated atropinic drugs, such as antiparkinsonians, H1 antihistamines, or imipraminic antidepressants in these patients.
抗精神病药物具有阿托品样（抗胆碱能）副作用，可能引发多种药物不良反应（ADR），如记忆丧失或认知障碍。本研究旨在调查接受抗精神病药物治疗患者的抗胆碱能负担。提取了2000年至2015年间在南比利牛斯药物警戒数据库中登记的所有至少包含一种抗精神病药物的ADR报告，并使用抗胆碱能杜兰列表进行分析。这项横断面研究的主要目的是计算接受抗精神病药物治疗患者的抗胆碱能负担；次要目的是调查相关因素。在1948份报告中，每份报告中阿托品样药物的平均数量为2.4±1.4。除抗精神病药物外，59.4%的报告（1158份）中发现了至少一种阿托品样药物。每份报告的平均抗胆碱能负担为3.9±2.9。61.7%的报告中该值≥3。发现抗胆碱能负担与患者年龄和男性性别之间存在显著关联。在研究期间，抗胆碱能负担的平均值保持稳定。本研究显示接受抗精神病药物治疗患者的抗胆碱能负担值较高。因此，考虑到阿托品样特性对认知功能潜在的有害临床影响，应采用适当方法减少抗胆碱能负担高的抗精神病药物的处方，同时也应减少这些患者中其他常与之联用的阿托品样药物（如抗帕金森病药物、H1抗组胺药或丙咪嗪类抗抑郁药）的联用处方。
