Unveiling the Limits of Anticholinergic Burden Scales: A Study of Adverse Drug Reactions in the French
Pauline-Eva Pecquet1, Julien Moragny1, Valérie Gras1
1Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, 80054, Amiens, France.
Background And Hypothesis:
The anticholinergic burden is the cumulative effect of drugs with anticholinergic properties and is typically measured using one of several anticholinergic scales. We hypothesised that these scales may not fully capture all the relevant adverse drug reactions (ADRs). By accessing the French national pharmacovigilance database (FPVD) and focusing on drug classes known to induce anticholinergic ADRs, the objectives of the present study were to describe the reported ADRs, characterise the drugs involved, and examine the drugs' classification within anticholinergic scales.
Methods:
Cases were extracted from the FPVD (1985-2024) when the suspected drug (i) had a high anticholinergic score, according to one or more of 22 anticholinergic burden scales, or (ii) belonged to the same class as the drug identified in (i). The anticholinergic ADRs investigated were confusion, glaucoma, tachycardia, urinary retention, constipation, intestinal obstruction and mydriasis.
Results:
Of the 101,365 cases reported in the FPVD, regarding the selected drugs, 9629 (9.5%) involved at least one anticholinergic ADR investigated. Patients who experienced at least one anticholinergic ADR had a median age of 61 years (interquartile range: 38-79), and the majority were women (58%). Confusion was the most frequently reported anticholinergic ADR (4603 cases, of which 81% were classified as serious), followed by tachycardia (n = 1541 cases, 70% serious), and urinary retention (1061 cases, 75% serious). It is noteworthy that 98% of the 561 reported cases of intestinal obstruction were classified as serious. The drug classes with the highest number of reports were (by far) anxiolytics, antidepressants, and antipsychotics. Some drugs linked to anticholinergic ADRs in the FPVD were not present in (or were assigned a low score by) commonly used anticholinergic scales, such as the Anticholinergic Cognitive Burden.
Conclusions:
Anticholinergic ADRs affect both older and younger adults. The existing scoring systems might not fully capture the range of medications involved in real-world anticholinergic-related events.
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