Amitriptyline's anticholinergic adverse drug reactions-A systematic multiple-indication review and meta-analysis
Maria-Sophie Brueckle1, Elizabeth T Thomas2, Svenja Elisabeth Seide3
1Institute of General Practice, Goethe University, Frankfurt, Germany.
Plos One
|April 5, 2023
Summary
Amitriptyline significantly increases the risk of anticholinergic adverse drug reactions (ADRs), such as dry mouth and drowsiness. These side effects were more common than non-anticholinergic ADRs in patients taking amitriptyline.
Area of Science:
- Pharmacology
- Clinical Trials
- Drug Safety
Background:
- Anticholinergic medications are widely used, but their risks may exceed benefits.
- Amitriptyline is a frequently prescribed, strongly anticholinergic drug.
- Understanding its adverse drug reactions (ADRs) is crucial.
Purpose of the Study:
- To quantify anticholinergic ADRs in patients taking amitriptyline compared to placebo.
- To analyze ADRs across various randomized controlled trials (RCTs).
Main Methods:
- Systematic review and meta-analysis of RCTs comparing oral amitriptyline to placebo.
- Included studies had ≥100 participants aged ≥18 years.
- Primary outcome was the frequency of anticholinergic ADRs.
Main Results:
- Twenty-three RCTs involving 4217 patients were analyzed.
- Amitriptyline significantly increased the odds of anticholinergic ADRs (OR = 7.41).
- Common ADRs included dry mouth and drowsiness; non-anticholinergic ADRs were similar to placebo.
Conclusions:
- ADRs indicative of anticholinergic activity are attributable to amitriptyline.
- Findings may be limited in older populations; future research should focus on this demographic.
- Anticholinergic ADRs were not found to be dose-dependent in this analysis.
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