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5PSQ-045 Analysis of a pharmaceutical intervention in polymedicated patients with dementia and in treatment with high anticholinergic activity drugs
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  1. MC Sánchez Argaiz,
  2. M Gallego Galisteo,
  3. A Trujillano Ruiz,
  4. AJ Villa Rubio,
  5. E Campos-Davila
  1. Hospital Nuevo La Línea de La Concepción, Hospital Pharmacy, La Línea de La Concepción, Spain

Abstract

Background and Importance Medicines with anticholinergic properties are frequently prescribed in older populations for different medical conditions increasing the risk of cognitive and functional disorders. Patients with dementia in treatment with acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) are also more vulnerable to these drug-related problems, not only because of the adverse impact of the cumulative anticholinergic effect but also because the effects of anticholinergics and acetylcholinesterase inhibitors (AChEi) oppose each other and may result in a diminished therapeutic effect.

Aim and Objectives To analyse the pharmaceutical intervention carried out in polymedicated patients with dementia and taking high anticholinergic activity drugs.

Material and Methods Observational, descriptive and prospective study in which the pharmaceutical interventions performed between June to August 2023 in five primary health-care centres. Polymedicated patients (≥ 5 drugs) with dementia and AChEi drugs and concomitant treatment with high anticholinergic burden were selected. The clinician received a review of the potential drug interaction with clinical evidence and a list of patients eligible for deprescription. After one month we reviewed if the pharmaceutical intervention was accepted or not with any patient prescription change: reduced dose of anticholinergic drug, suspension or substitution of any drug.

Results During the study period, 49 polymedicated outpatients were included, 29% men, 79 (75–96) years median age. Median prescribed drugs 12 (10–22). According to the ATC classification, the high anticholinergic activity drug prescribed were: 21% (10) Antimuscarinic overactive bladder, 4% (2) Antimuscarinic spasmolytic, 8% (4) Antihistamines, 8% (4) Antipsychotropic, 41% (20) Tricyclic antidepressants, 18% (9) Selective serotonin reuptake inhibitor. Acceptance of pharmaceutical intervention with any change in prescription: 43% (21). 14 (66%) anticholinergic drugs were suspended, 2 (10%) reduce dose of anticholinergic drug, 2 (10%) increase dose of AChEi drugs or added memantine, 3 (14%) change the high anticholinergic activity drug.

Conclusion and Relevance This study highlights the need and importance to review the chronic medication and to measure the anticholinergic burden in old patients above all in dementia diagnosis. Most guides recommend the avoidance of the combination of anticholinergic drug and acetylcholinesterase inhibitors drugs if it is possible and this study gives us an idea of the benefit of having a pharmacist as part of the multidisciplinary team reviewing polymedicated patients to prioritise interventions in patients at highest risk of suffering adverse drug events.

Conflict of Interest No conflict of interest.

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