Ueda Akihito, Obara Michiko, Watanabe Shinichi
Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan.
Medical Corporation Toujinkai, Fujitate Hospital, 5-4-24 Omiya Asahi-Ku, Osaka-Shi, Osaka-Hu, 535-0002, Japan.
J Pharm Health Care Sci. 2025 Aug 5;11(1):66. doi: 10.1186/s40780-025-00474-x.
The 2022 revision of Japanese healthcare reimbursement removed pharmacists from the mandatory dysphagia team, despite emerging evidence of medication-related swallowing complications. Our previous pharmacovigilance analysis identified dopamine-blocking drugs as primary contributors to the risk of aspiration pneumonia. This study aimed to validate these findings through a clinical examination of pharmaceutical interventions performed by a multidisciplinary dysphagia team.
This retrospective observational study was conducted at a 97-bed community hospital in Osaka, Japan, from June 2023 to January 2024. All adult patients with suspected dysphagia who underwent a multidisciplinary team intervention were included in our analysis. Pharmaceutical intervention was requested when medication-related dysphagia or swallowing difficulties were suspected, with interventions classified into the following four categories: drug-induced dysphagia management, dosage form optimization, swallowing aid utilization, and medication burden reduction. Changes in the medication burden were analyzed using paired t-tests.
Among 59 patients with dysphagia (mean age, 81.1 ± 9.8 years; 33 males [55.9%], 26 females [44.1%]), 13 (22.0%) underwent pharmaceutical interventions. Drug-induced dysphagia management was the most common intervention (69.2%), targeting dopamine antagonists (sulpiride, risperidone, tiapride, and domperidone), benzodiazepines, and anticholinergics without dopamine-blocking effects. Suspected drug-induced dysphagia was the most common symptom among patients with dementia (38.9%). The intervention group showed a significant reduction in medication (mean, -3.2 medications; P < 0.001), whereas the non-intervention group showed no change. Among the non-intervention group, potential opportunities for the optimization of angiotensin-converting enzyme inhibitors were identified in antihypertensive therapy.
Pharmaceutical interventions may offer clinically meaningful contributions when utilized for patients with dysphagia, supporting the relevance of pharmacovigilance regarding the risks of dopamine antagonists. The findings of this study suggest the importance of reinstating pharmaceutical expertise to multidisciplinary dysphagia teams, as pharmacists provide clinically significant medication optimization, including identifying additional optimization opportunities through systematic medication reviews among vulnerable populations.
尽管有越来越多的证据表明存在与药物相关的吞咽并发症，但日本2022年的医疗报销修订将药剂师从强制性吞咽困难治疗团队中移除。我们之前的药物警戒分析确定多巴胺阻断药物是吸入性肺炎风险的主要促成因素。本研究旨在通过对多学科吞咽困难治疗团队实施的药物干预进行临床检查来验证这些发现。
这项回顾性观察研究于2023年6月至2024年1月在日本大阪一家拥有97张床位的社区医院进行。所有接受多学科团队干预的疑似吞咽困难的成年患者均纳入我们的分析。当怀疑存在与药物相关的吞咽困难或吞咽困难时，要求进行药物干预，干预分为以下四类：药物性吞咽困难管理、剂型优化、吞咽辅助工具使用和药物负担减轻。使用配对t检验分析药物负担的变化。
在59例吞咽困难患者中（平均年龄81.1±9.8岁；男性33例[55.9%]，女性26例[44.1%]），13例（22.0%）接受了药物干预。药物性吞咽困难管理是最常见的干预措施（69.2%），针对多巴胺拮抗剂（舒必利、利培酮、硫必利和多潘立酮）、苯二氮䓬类药物和无多巴胺阻断作用的抗胆碱能药物。疑似药物性吞咽困难是痴呆患者中最常见的症状（38.9%）。干预组的药物数量显著减少（平均减少3.2种药物；P<0.001），而非干预组没有变化。在非干预组中，在抗高血压治疗中发现了优化血管紧张素转换酶抑制剂的潜在机会。
药物干预应用于吞咽困难患者时可能会提供具有临床意义的帮助，支持对多巴胺拮抗剂风险进行药物警戒的相关性。本研究结果表明，将药学专业知识重新纳入多学科吞咽困难治疗团队很重要，因为药剂师可提供具有临床意义的药物优化，包括通过对弱势群体进行系统的药物审查来识别更多的优化机会。
