抗胆碱能药物的过去、现在与未来。
The past, present and future of anticholinergic drugs.
作者信息
Healy David
机构信息
Data Based Medicine Americas Ltd., 95 Sandringham Drive, Toronto, ON, M3H 1E1 Canada.
出版信息
Ther Adv Psychopharmacol. 2023 Sep 8;13:20451253231176375. doi: 10.1177/20451253231176375. eCollection 2023.
In current medical practice, it is difficult to find any reports claiming that drugs that are primarily anticholinergic or those that have significant anticholinergic effects have any therapeutic benefits. These drugs fell into disrepute within the mental health field from the mid-1960s onwards, and their supposed problems extended to elsewhere in medicine after that. There is considerable evidence that this disrepute stemmed more from marketing copy rather than from hard clinical trial data. Many apparent reviews appear to repeat prior claims rather than present substantial or new evidence. This article offers a perspective rather than a systematic review as there is little evidence other than claims to review. The aim is to challenge the conventional narrative that anticholinergic effects are uniquely hazardous by pointing to the uncertain basis for claims about the harms of anticholinergic drugs, antimuscarinic drugs in particular, ending with pointers to recent research that, if realized, might underpin important possible future benefits.
在当前的医学实践中,很难找到任何报告称主要具有抗胆碱能作用的药物或具有显著抗胆碱能效应的药物具有任何治疗益处。从20世纪60年代中期起,这些药物在心理健康领域声名狼藉,之后其所谓的问题在医学的其他领域也有所蔓延。有大量证据表明,这种声名狼藉更多源于营销文案,而非确凿的临床试验数据。许多表面上的综述似乎只是重复先前的说法,而没有提供实质性的或新的证据。由于除了说法之外几乎没有证据可供综述,本文提供的是一种观点,而非系统综述。目的是通过指出关于抗胆碱能药物(尤其是抗毒蕈碱药物)危害的说法缺乏确凿依据,来挑战抗胆碱能效应具有独特危险性的传统观点,并以近期研究的要点作为结尾,如果这些研究得以实现,可能会带来未来重要的潜在益处。