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PHARMACODYNAMICS

Anticholinergic Activity of Commonly Prescribed Medications and Neuropsychiatric Adverse Events in Older People

Prasad S. Nishtala, MPharm, Romano A. Fois, PhD, Andrew J. McLachlan, PhD, J. Simon Bell, PhD, Patrick J. Kelly, PhD and Timothy F. Chen, PhD

From the Faculty of Pharmacy, University of Sydney, NSW, Australia (Mr Nishtala, Dr Fois, Dr McLachlan, Dr Bell, Dr Chen); Centre for Education and Research on Ageing, Concord Hospital, Concord, NSW, Australia (Dr McLachlan); Kuopio Research Centre of Geriatric Care, University of Kuopio, Finland (Dr Bell); Department of Pharmacology and Toxicology, University of Kuopio, Finland (Dr Bell); and School of Public Health, University of Sydney, NSW, Australia (Dr Kelly).

This study sought to determine whether the presence of in vitro anticholinergic activity (AA) among different drugs is associated with reporting of neuropsychiatric adverse events (NPAEs) and whether age affects this relationship. Retrospective case/noncase analyses using Australia's spontaneous Adverse Drug Reaction System (ADRS) database containing 150 475 reports determined crude and adjusted reporting odds ratios (RORs) for NPAEs for 23 drugs with various reported in vitro AA. Covariates were age (treated as a dichotomous variable [≥65 years]), gender, and concomitant use of antipsychotics, benzodiazepines, tricyclic antidepressants, and drugs with recognized inherent anticholinergic properties (anticholinergic drugs). The interaction effect between these covariates and each drug exposure category was examined. Age (≥65 years) has a significant association with greater odds relative to younger age for reporting NPAEs. Drugs with reported significant AA in vitro were not always associated with RORs greater than 1 for reporting NPAEs, highlighting a dissonance between the in vitro AA index and ADRS observations. Significant interactions were observed between age (≥65 years) and exposure to cimetidine, anticholinergic drugs, antipsychotics, and tricyclic antidepressants in modifying odds for reporting NPAEs, reinforcing the need for cautious use and monitoring of drugs with AA in older people.

Key Words: Anticholinergic • older people • neuropsychiatric adverse events • adverse drug reaction • spontaneous reporting system

Address for reprints: Prasad S. Nishtala, MPharm, Faculty of Pharmacy, University of Sydney, NSW 2006, Australia; e-mail: prasadn{at}pharm.usyd.edu.au.


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