Potentially Inappropriate Prescriptions for Anticholinergic Medications for Patients with Constipation

Constipation is a very common functional gastrointestinal disorder in the general population and can be primary or secondary.

The aim of this study was to estimate the anticholinergic burden of prescribed drugs in a population diagnosed with constipation in Colombia.

This was a cross-sectional study that used a population database of 6.5 million people to identify the prescription of cholinergic antagonists and drugs for the management of constipation in outpatient services. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. Potentially inappropriate prescriptions that increased the risk of constipation were identified.

A total of 3,887 patients with constipation were identified; the identified patients had a mean age of 54.4 ± 21.9 years, and 69.4% were women. Eighty percent received at least one laxative, and the most prescribed laxative was bisacodyl (50.5%). Forty-one percent (n = 1,586) of all patients received drugs with cholinergic antagonist activity, in particular codeine (6.5%) and valproic acid (6.5%). Being over 30 years of age (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.24-2.57), being treated in the cities of Manizales (OR: 2.20; 95% CI: 1.50-3.21) and Pereira (OR: 1.49; 95% CI: 1.07-2.09), and having hypothyroidism as a comorbidity (OR: 1.37; 95% CI: 1.08-1.73) were associated with a greater probability of receiving medications with an anticholinergic burden of 3 or more points.

The majority of patients with constipation were women and were using laxatives to manage constipation. A large proportion of patients were prescribed at least one cholinergic antagonist drug, with an increased probability of use after 30 years of age.