Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Department of Psychiatry and Psychotherapy, Vitos Klinikum Hochtaunus, Friedrichsdorf, Germany.
J Neural Transm (Vienna). 2021 Feb;128(2):263-272. doi: 10.1007/s00702-020-02298-5. Epub 2021 Jan 13.
Due to the high number of psychotropic drugs with anticholinergic potential, patients taking psychotropic drugs are at high risk for anticholinergic adverse drug reactions (ADRs). The aim of this study was to analyze the prevalence and type of pharmacodynamic anticholinergic drug-drug interactions in psychiatric patients. The retrospective longitudinal analysis used data from a large pharmacovigilance study conducted in ten German psychiatric hospitals. Anticholinergic burden of drugs was defined as "strong" or "moderate" based on current literature. Number and type of anticholinergic drugs were assessed. In total, 27,396 patient cases (45.6% female) with a mean age of 47.3 ± 18.3 years were included. 17.4% (n = 4760) of patients were ≥ 64 years. 35.4% of the patients received between one and four anticholinergic drugs simultaneously. A combination of drugs with anticholinergic potential was detected in 1738 cases (6.3%). Most prescribed drugs were promethazine (n = 2996), olanzapine (n = 2561), biperiden (n = 1074), and doxepin (n = 963). Patients receiving anticholinergic combinations were younger (45.7 vs. 47.4 years, p < 0.01) and had a longer inpatient stay (median 18 vs. 26.5 days, p < 0.001). The prevalence of anticholinergic drug use in psychiatry is high. Further efforts need to focus on reducing the rate of anticholinergics and inappropriate medication especially in the elderly. Anticholinergic ADRs can be prevented by avoiding high-risk drug combinations. Replacing tricyclic antidepressants and first-generation antihistamines with drugs with lower anticholinergic potential and avoiding biperiden could reduce 59.3% of anticholinergic drug application.
由于具有抗胆碱能潜力的精神药物数量众多，因此服用精神药物的患者发生抗胆碱能药物不良反应（ADR）的风险很高。本研究旨在分析精神科患者中药物动力学抗胆碱能药物相互作用的发生率和类型。这项回顾性纵向分析使用了在德国十家精神病院进行的大型药物警戒研究的数据。根据当前文献，将药物的抗胆碱能负担定义为“强”或“中度”。评估了抗胆碱能药物的数量和类型。总共纳入了 27396 例患者病例（45.6%为女性），平均年龄为 47.3±18.3 岁。17.4%（n=4760）的患者年龄≥64 岁。35.4%的患者同时服用一到四种具有抗胆碱能潜力的药物。在 1738 例（6.3%）患者中发现了具有抗胆碱能潜力的药物组合。最常开的药物是异丙嗪（n=2996）、奥氮平（n=2561）、比哌立登（n=1074）和多塞平（n=963）。接受抗胆碱能药物联合治疗的患者更年轻（45.7 岁 vs. 47.4 岁，p<0.01），住院时间更长（中位数 18 天 vs. 26.5 天，p<0.001）。精神科抗胆碱能药物的使用频率很高。需要进一步努力降低抗胆碱能药物和不适当药物的使用率，特别是在老年人中。通过避免高危药物组合，可以预防抗胆碱能 ADR。用抗胆碱能潜力较低的药物替代三环类抗抑郁药和第一代抗组胺药，并避免使用比哌立登，可以减少 59.3%的抗胆碱能药物应用。
