Article Text

Download PDFPDF

5PSQ-090 Anticholinergic drugs and acetylcholinesterase inhibitors: a non-recommended combination
  1. M Oro Fernandez1,
  2. CM Valencia Soto1,
  3. JI Gutierrez Revilla1,
  4. F Perez Hernandez2,
  5. A Tejerina3
  1. 1Cantabria Health Service, Unit of Medicines Reconciliation, Santander, Spain
  2. 2Cantabria Health Service, Chief of the Pharmaceutical Management Service, Santander, Spain
  3. 3Cantabria Health Service, Director of Health Assistance, Santander, Spain


Background Anticholinergic drugs exert their effect by the opposite mechanism to acetylcholinesterase inhibitors (AChEIs), helping to counteract their modest efficacy and favouring the appearance of adverse events.

Purpose To determine the prevalence of patients with concomitant prescription of AChEIs and anticholinergics in an institutionalised population and to analyse their associated characteristics.

Material and methods Cross-sectional descriptive study carried out in August 2018 including patients from three nursing homes with concomitant prescription of AChEIs and anticholinergic drugs.

Variables were: age, sex, number of drugs, Charlson Index Score (ChI), presence, type and level of cognitive disorder (CD) and anticholinergic and AChEI prescribed.

To identify anticholinergic drugs we used The Anticholinergic-Cognitive-Burden (ACB) scale. Accumulated score ≥3 was considered elevated. To evaluate CD, we used the global deterioration scale (GDS), considering valid the scores from the past 18 months.

Results We found 219 patients with CD out of our 367 sample. 22.,4% patients with the concomitant prescription (n=49) were selected. Average age was 86.4±5.3, 79.6% (n=39) females. Average ChI score was 6.2±1.2 and the median number of drugs nine (2–17).

Regarding diagnosis: 43% Alzheimer’s disease, 28,6% mixed dementia, 18,4% Lewy–Body dementia and 10% others.

The deterioration degree was 36.7% from moderately-severe to severe cognitive decline, 12.2% from severe to very severe and 3% from mild to moderate and from moderate to moderately-severe. This data was not available/updated in 38.8% patients.

Rivastigmine (53%) was the most prescribed AChEI, followed by donepezil (35%) and galantine (12%). Anticholinergics were prescribed in 71% (n=35) patients with AChEI. Eighty-five per cent (n=30) had elevated AB.

A total of 67 prescriptions of anticholinergic drugs were detected (1.91/patient). Eighty-two per cent belonged to ‘Nervous System’(ATC N). Sixteen prescriptions corresponded to drugs with 3 points on the ACB scale. Quetiapine (87.5%) was the most prescribed. The remaining 51 corresponded to drugs with 1 point. Trazodone (47%) was the most frequently implicated drug.

No statistically significant differences in taking anticholinergic drugs were found between those taking AChEIs or not.

Conclusion Almost half of our population presented an important/severe CD degree. Concomitant prescription of anticholinergics and AChEIs was frequent. Drugs from NS were the most implicated. It was not more likely to take anticholinergics among those taking AChEIs.

A reappraisal of the therapeutic approach should be periodically considered in this vulnerable group of patients.

References and/or acknowledgements No conflict of interest

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.