Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Many Alzheimer’s patients get drugs with opposing effects

But no higher risk of death or nursing home entry with choline drug conflict
Study link: Concomitant use of cholinesterase inhibitors and anticholinergics: prevalence and outcomes

You wouldn’t brake your car while stepping on the gas — or wash down a sleeping pill with espresso. Yet many people taking common Alzheimer’s disease medications—cholinesterase inhibitors—are 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 drugs—cholinesterase inhibitors and anticholinergic medications—they 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, anticholinergics—such 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 drugs—and 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.

A contract with the National Heart, Lung, and Blood Institute supported this research.

Dr. Boudreau’s co-authors are Senior Biostatistician Onchee Yu, MS, Group Health Vice President for Research and Executive Director Eric B. Larson, MD, MPH, and Jeanene Johnson, MPH, of Group Health Research Institute, in Seattle; Shelly L. Gray, PharmD, MS, of the University of Washington; and Marsha A. Raebel, PharmD, of the Kaiser Permanente Colorado Institute for Health Research and the University of Colorado at Denver. Drs. Boudreau and Larson are also affiliated with the University of Washington.

The Journal of the American Geriatrics Society
The Journal of the American Geriatrics Society is a comprehensive and reliable source of monthly research and information about common diseases and disorders of older adults.
Group Health Research Institute
Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.

Rebecca Hughes | EurekAlert!
Further information:

More articles from Health and Medicine:

nachricht Advanced analysis of brain structure shape may track progression to Alzheimer's disease
26.10.2016 | Massachusetts General Hospital

nachricht Indian roadside refuse fires produce toxic rainbow
26.10.2016 | Duke University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Etching Microstructures with Lasers

Ultrafast lasers have introduced new possibilities in engraving ultrafine structures, and scientists are now also investigating how to use them to etch microstructures into thin glass. There are possible applications in analytics (lab on a chip) and especially in electronics and the consumer sector, where great interest has been shown.

This new method was born of a surprising phenomenon: irradiating glass in a particular way with an ultrafast laser has the effect of making the glass up to a...

Im Focus: Light-driven atomic rotations excite magnetic waves

Terahertz excitation of selected crystal vibrations leads to an effective magnetic field that drives coherent spin motion

Controlling functional properties by light is one of the grand goals in modern condensed matter physics and materials science. A new study now demonstrates how...

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Greater Range and Longer Lifetime

26.10.2016 | Power and Electrical Engineering

VDI presents International Bionic Award of the Schauenburg Foundation

26.10.2016 | Awards Funding

3-D-printed magnets

26.10.2016 | Power and Electrical Engineering

More VideoLinks >>>