Navigation Links
Many Alzheimer's patients get drugs with opposing effects

SEATTLE, WAYou wouldn't brake your car while stepping on the gasor wash down a sleeping pill with espresso. Yet many people taking common Alzheimer's disease medicationscholinesterase inhibitorsare given medications with anticholinergic properties, which oppose their effects. Group Health Research Institute scientists investigated how often that happens and reported on the consequences in an "Early View" study e-published in the Journal of the American Geriatrics Society.

"Cholinesterase inhibitors are today's primary therapy for slowing Alzheimer's disease," said study leader Denise Boudreau, PhD, RPh, an associate scientific investigator at Group Health Research Institute. "Anticholinergic properties are often found in drugs commonly used to treat gastrointestinal disorders, allergies, urinary incontinence, depression, and Parkinson's disease, and they can have negative effects on cognition and function in the elderly. There's concern that if someone is taking both types of drugscholinesterase inhibitors and anticholinergic medicationsthey will antagonize each other, and neither will work."

In clinical trials, cholinesterase inhibitors show modest effects against the functional and cognitive decline of people with Alzheimer's disease. These medications, such as donepezil (Aricept) work by inhibiting the breakdown of acetylcholine, which sends signals in the nervous system. By contrast, anticholinergicssuch as diphenhydramine (Benadryl) and oxybutynin (Ditopan)block the action of acetylcholine. Since the two types of drugs have opposite effects, it makes sense not to give both kinds of drugs to an individual person. But until Dr. Boudreau's study, few researchers had explored how often patients are prescribed both types of medications and which harms this might cause.

Dr. Boudreau and colleagues conducted a retrospective cohort study of 5,625 people aged 50 or older who received a new prescription for cholinesterase inhibitors between 2000 and 2007. The researchers used electronic pharmacy records of Group Health Cooperative and Kaiser Permanente Colorado, nonprofit health care systems that together provide care to more than a million people. The research team found patients who also had a prescription for anticholinergics from the year before their cholinesterase prescription until the analysis ended on December 31, 2008, or the patient left the health care system or died. The study was the first to use state death records and insurance claims for nursing home care to look for effects of taking both drug types.

The researchers found:

  • Of the cholinesterase inhibitor users, 37 percent were also taking at least one anticholinergic drug, and more than 11 percent took two or more. This was similar to other studies of Medicare beneficiaries.

  • For those using both medication types, dual use generally lasted three to four months, but 25 percent used both classes of drugs for more than a year.

  • Anticholinergics were already being used in 23 percent of people receiving a new cholinesterase inhibitor prescription, and 77 percent continued, even after starting the cholinesterase inhibitor.

  • Subjects using both medication types were not more likely to enter a nursing home or to die than those taking only cholinesterase inhibitors.

"It's reassuring that we did not observe an association between simultaneous use of the two types of drugs and increased risk of death or nursing home placement," said Dr. Boudreau. "But concomitant use of these drugs is, at the very least, not optimal clinical practice." Preventing concurrent use of opposing drugs could also be a chance to reduce waste in health care spending, since a month of donepezil treatment costs approximately $180.

One reason that health care providers might prescribe conflicting medications is that dementia patients often have multiple medical conditions. Also, anticholinergics are often given to counteract the side effects of cholinesterase inhibitors, which are one of the few available treatments for people with Alzheimer's. Dr. Boudreau hopes the study raises awareness about the potential inappropriateness of prescribing both types of drugsand stimulate discussions about the best way to make therapeutic decisions for people with Alzheimer's.

"Providers, families, and patients should carefully consider the extent to which demonstrated benefits or harms in an individual patient justify long-term use of these drugs," said Dr. Boudreau. "A good first step is to have clearly agreed-upon goals for therapy and a plan to monitor for effects and side effects." Now Group Health Research Institute scientists have started to work with Group Health Cooperative on steps like these to improve the quality of care.


Contact: Rebecca Hughes
Group Health Research Institute

Related medicine news :

1. Mood, cognition and sleep patterns improve in Alzheimers patients after cataract surgery
2. Vitamin B-based treatment for corneal disease may offer some patients a permanent solution
3. Rehab helps heart patients live longer -- but they have to show up
4. Biomarker detects graft-versus-host-disease in cancer patients after bone marrow transplant
5. PATH B, a comprehensive support program in Europe for patients with chronic hepatitis B launched
6. NIPPV linked to increased hospital mortality rates in small group of patients
7. Hospital patients suffer in shift shuffle
8. ASE-EAE to issue guidelines for the echocardiographic evaluation of cancer patients
9. Start HIV Drug Treatment Early in Patients With TB: Studies
10. Early HIV treatment dramatically increases survival in patients co-infected with tuberculosis
11. Most breast cancer patients do not have breast reconstruction surgery
Post Your Comments:
Related Image:
Many Alzheimer's patients get drugs with opposing effects
(Date:10/12/2015)... NJ (PRWEB) , ... October 12, 2015 , ... The ... programs and initiatives focused on improving public health and enhancing the quality of life ... will go to 11 New Jersey non-profit organizations. , The charitable arm of ...
(Date:10/12/2015)... ... October 12, 2015 , ... Advera Health Analytics, Inc . ... qualified Managed Care Organizations (MCOs) in order to provide health plans, payers, systems, and ... making process. In addition, the DSM is also being offered to healthcare media organizations ...
(Date:10/12/2015)... ... October 12, 2015 , ... A new invention has just been ... An inventor from Rutland, Mass., has modified a conventional nasal aspirator with child safety ... in withdrawing mucus from sinuses and nasal passages more safely and effectively than with ...
(Date:10/12/2015)... , ... October 12, 2015 , ... NFL football fans who are interested in having ... a great cause. CLICK HERE to donate to Smile for a Lifetime (S4L) ... to win an all-inclusive trip to the 2016 NFL Super Bowl! , Donors contributing $20.00 ...
(Date:10/12/2015)... York, NY (PRWEB) , ... October 12, 2015 ... ... Inc., Care to Care has secured a new corporate headquarters, located at 485 ... will allow for improved workflow and increased emphasis on cloud-based technology. , “Care ...
Breaking Medicine News(10 mins):
(Date:10/12/2015)... ) ... "Personalized Medicine, Targeted Therapeutics and Companion Diagnostic ... Industry Trends, Technologies, Participants, and Environment" ... ) has announced the addition of ... Companion Diagnostic Market to 2019 - Strategic ...
(Date:10/12/2015)... St. Paul, Minn. , Oct. 12, 2015 /PRNewswire/ ... with it, a need to help integrate these devices ... global leader of ergonomic healthcare mounting and mobility solutions, ... Carts, its lightest cart yet, for a wide array ... StyleView S-Tablet Cart SV10 was developed exclusively for Microsoft ...
(Date:10/12/2015)... 12, 2015 ... grow at 7.2% CAGR, microscopy market growth ... focus on nanotechnology, technological advancements, and increasing ... available with ... --> Complete report on microscopy ...
Breaking Medicine Technology: