Zaragoza Noguera R, Ballester Montilla A, Somoza Hernández B
Licenciado en Farmacia. Oficina de Farmacia Rogelio Zaragoza. Beniaján. Murcia. España.
Técnico especialista en Laboratorio de Análisis Clínico. Oficina de Farmacia Rogelio Zaragoza. Beniaján. Murcia España.
Farm Comunitarios. 2025 Apr 2;17(2):30-43. doi: 10.33620/FC.2173-9218.(2025).12. eCollection 2025 Apr 15.
The current aging of the population leads to an increase in morbidity and mortality, especially due to the higher incidence of chronic diseases and the need for associated polymedication. Among the drugs that are usually used to treat the most common pathologies in elderly patients, there are a large number of drugs with anticholinergic activity, which translates into anticholinergic effects, adverse effects that, although they can appear at any age, are especially significant in older patients, in whom the associated clinical consequences are important.
To analyze the use of anticholinergic activity drugs in outpatients, anticholinergic adverse effects and the anticholinergic burden associated with the chronic treatment of such patients.
A descriptive, observational, cross-sectional study was carried out in polymedicated patients who came to the pharmacy to pick up their medication, which included at least one drug with AA. The anticholinergic burden was calculated with the online application "ACB calculator", using the anticholinergic load value given by the ARS, ADS, ACB and DBI scales.The association between anticholinergic burden and adverse effects manifested in the last six months, the pathologies present, the pharmacological groups used and the number of prescribed drugs with anticholinergic activity were analyzed. In the statistical analysis, the "Spearman's Rho" correlation coefficient was used to study the correlation between the different variables, and the non-parametric "Mann-Whitney U" test was used to study the relationship between anticholinergic adverse effects and anticholinergic burden. The level of statistical significance was set at p<0.05.
A total of 44 patients were analyzed, with a mean age of 73.36 ± 12.34 years, of which 77.3% were women. The most frequent anticholinergic adverse effects were, at peripheral level dry mouth and constipation (54.5% and 38.6% respectively), and at central level dizziness and memory loss (31.8% and 40.9%, respectively). The patients took an average of 10.86 ± 3.88 drugs daily, of which 34% had anticholinergic activity. The drugs most frequently used by the patients were tramadol (27.2%) and lorazepam (34.1%). Statistically significant correlations were obtained between: i) the number of central anticholinergic adverse effects using the ARS (P=0.009, CI:0.097-0.622) and ADS (P=0.017, CI:0.061-0.872) scales, ii) the Drug Burden Index (DBI) and the number of prescribed drugswith anticholinergic activity (P<0.001, CI:0.558-0.851), iii) the DBI index and drugs in the groups N02 (analgesics) (P<0.001, CI:0.279-0.724), N06 (psychoanaleptics) and N06A (antidepressants) with the ARS scale (P<0.001, CI:0.416-0.791; P<0.001, CI:0.345-0.757, respectively).
The population studied is exposed to a high number of drugs with anticholinergic activity, mainly psycholeptics, psychoanaleptics and opioid analgesics, which, although the most prescribed do not have a high anticholinergic activity, do contribute to the anticholinergic load of the treatments.
当前的人口老龄化导致发病率和死亡率上升，特别是由于慢性病发病率较高以及相关多药治疗的需求。在通常用于治疗老年患者最常见病症的药物中，有大量具有抗胆碱能活性的药物，这会转化为抗胆碱能效应，尽管这些不良反应在任何年龄都可能出现，但在老年患者中尤为显著，其相关临床后果较为严重。
分析门诊患者中抗胆碱能活性药物的使用情况、抗胆碱能不良反应以及此类患者长期治疗相关的抗胆碱能负担。
对到药房取药的多药治疗患者进行了一项描述性、观察性横断面研究，这些患者至少服用一种具有抗胆碱能活性（AA）的药物。使用在线应用程序 “ACB计算器”，根据ARS、ADS、ACB和DBI量表给出的抗胆碱能负荷值计算抗胆碱能负担。分析了抗胆碱能负担与过去六个月出现的不良反应、存在的病症、使用的药理组以及开具的具有抗胆碱能活性药物数量之间的关联。在统计分析中，使用 “Spearman相关系数” 研究不同变量之间的相关性，使用非参数 “Mann-Whitney U检验” 研究抗胆碱能不良反应与抗胆碱能负担之间的关系。统计学显著性水平设定为p<0.05。
共分析了44例患者，平均年龄为73.36±12.34岁，其中77.3%为女性。最常见的抗胆碱能不良反应在周围水平为口干和便秘（分别为54.5%和38.6%），在中枢水平为头晕和记忆力减退（分别为31.8%和40.9%）。患者平均每天服用10.86±3.88种药物，其中34%具有抗胆碱能活性。患者最常使用的药物是曲马多（27.2%）和劳拉西泮（34.1%）。在以下方面获得了统计学显著相关性：i）使用ARS量表（P=0.009，CI：0.097-0.622）和ADS量表（P=0.017，CI：0.061-）时中枢抗胆碱能不良反应的数量；ii）药物负担指数（DBI）与开具的具有抗胆碱能活性药物的数量（P<0.001，CI：0.558-0.851）；iii）DBI指数与N02组（镇痛药）（P<0.001，CI：0.279-0.724）、N06组（精神兴奋药）和N06A组（抗抑郁药）中的药物与ARS量表（P<0.001，CI：0.416-0.791；P<0.001，CI：0.345-0.7分别）。
所研究的人群接触大量具有抗胆碱能活性的药物，主要是抗精神病药、精神兴奋药和阿片类镇痛药，尽管开具最多的药物抗胆碱能活性不高，但确实增加了治疗的抗胆碱能负荷。
