Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Int J Pharm Pract. 2020 Oct;28(5):466-472. doi: 10.1111/ijpp.12636. Epub 2020 May 10.
This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults.
An audit of outpatient prescriptions ordered for older adults aged ≥65 years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined.
The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy.
Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.
本研究评估了在巴林 24 家政府初级保健中心的≥65 岁患有一种或多种慢性病的社区居住老年人中，开具具有潜在致便秘作用的药物和预防性使用泻药的情况。
对负责每家医疗中心药剂师在 2015 年 12 月至 2016 年 6 月期间收集的 2106 例≥65 岁患有一种或多种慢性病的老年人的门诊处方进行审核。确定具有潜在致便秘作用的药物和同时开具泻药的处方比例。
具有致便秘作用的药物处方总体比例为 30.5%（642/2106）。至少开具一种抗胆碱能药物/具有抗胆碱能作用的药物（DAP）的处方比例为 22.5%（473/2106）：单一药物 16.6%（350/2106），两种或两种以上药物联合使用 5.9%（124/2106）。两种或两种以上抗胆碱能药物/DAP 联合使用占 2.9%（61/2106）处方。除抗胆碱能药物以外的致便秘药物，如多价阳离子制剂和非二氢吡啶钙通道阻滞剂，在 8.0%（168/2106）的病例中开具。具有高抗胆碱能药物负担的奥芬那君和第一代抗组胺药，单独或联合使用，均为常用药物。开具泻药的比例为 2.96%（19/642），主要是开具致便秘药物单药治疗的患者。
大约三分之一的老年人处方中开具了具有致便秘作用的药物，通常为单一 DAP。开具泻药的情况并不常见，与开具具有潜在致便秘作用的药物的流行率无关。应将医生对抗胆碱能药物及其潜在风险的认识以及预防性使用泻药来减轻医源性便秘纳入持续专业项目中。
