Abstract
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.
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Acknowledgements
The authors are very grateful to all ten participating hospitals for their voluntary collection of data.
Funding
The Federal Joint Committee (G-BA, project executing organization: Deutsches Zentrum für Luft- und Raumfahrt, DLR) is funding healthcare research projects that aim to optimize quality of care for statutory insured persons in Germany. In this regard, the innovative study “Optimization of pharmacological treatment in hospitalized psychiatric patients” (OSA-PSY, study number 01VSF16009, ethical approval reference number FF 116/2017) is sponsored by the DLR.
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Sermin Toto has been a member of an advisory board for Otsuka and Janssen Cilag and has received speaker´s honoraria from Janssen Cilag, Lundbeck, Otsuka and Servier. She reports no conflict of interest with this publication. Christoph Hiemke has received speaker’s and consultancy fees from Stada, Lohmann Transdermal Systems and Otsuka during the last 2 years. He reports no conflict of interest with this publication. All other authors declare no conflicts of interest.
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This study complies with ethical standards (ethical approval reference number FF 116/2017).
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Toto, S., Hefner, G., Hahn, M. et al. Current use of anticholinergic medications in a large naturalistic sample of psychiatric patients. J Neural Transm 128, 263–272 (2021). https://doi.org/10.1007/s00702-020-02298-5
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DOI: https://doi.org/10.1007/s00702-020-02298-5