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A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs.
Arch Intern Med. 2005 Apr 11; 165(7):808-13.AI

Abstract

BACKGROUND

The prescribing cascade model involves the misinterpretation of an adverse reaction to 1 drug and the subsequent, potentially inappropriate prescription of a second drug. We present a new example of the prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs used to manage urinary incontinence.

METHODS

A population-based retrospective cohort study was carried out in Ontario, Canada. Participants included 44,884 older adults with dementia (20,491 were dispensed a cholinesterase inhibitor and 24,393 were not), enrolled between June 1, 1999, and March 31, 2002. Subjects were observed until they received an anticholinergic drug, stopped the cholinesterase inhibitor treatment, died, or the study period ended (March 31, 2003). The main outcome measure was receipt of an anticholinergic drug to manage urinary incontinence.

RESULTS

After adjusting for potential confounding factors, we observed that older adults with dementia who were dispensed cholinesterase inhibitors had an increased risk of subsequently receiving an anticholinergic drug (4.5% vs 3.1%; P<.001; adjusted hazard ratio, 1.55; 95% confidence interval, 1.39-1.72), relative to those not receiving cholinesterase inhibitors. This finding was consistent in a series of subgroup analyses.

CONCLUSIONS

Use of cholinesterase inhibitors is associated with an increased risk of receiving an anticholinergic drug to manage urinary incontinence. The use of an anticholinergic drug in this setting may represent a clinically important prescribing cascade. Clinicians should consider the possible contributing role of cholinesterase inhibitors in new-onset or worsening urinary incontinence and the potential risk of coprescribing cholinesterase inhibitors and anticholinergic drugs to patients with dementia.

Authors+Show Affiliations

Institute for Clinical Evaluative Sciences, Toronto, Ontario. gills@pccchealth.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15824303

Citation

Gill, Sudeep S., et al. "A Prescribing Cascade Involving Cholinesterase Inhibitors and Anticholinergic Drugs." Archives of Internal Medicine, vol. 165, no. 7, 2005, pp. 808-13.
Gill SS, Mamdani M, Naglie G, et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med. 2005;165(7):808-13.
Gill, S. S., Mamdani, M., Naglie, G., Streiner, D. L., Bronskill, S. E., Kopp, A., Shulman, K. I., Lee, P. E., & Rochon, P. A. (2005). A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Archives of Internal Medicine, 165(7), 808-13.
Gill SS, et al. A Prescribing Cascade Involving Cholinesterase Inhibitors and Anticholinergic Drugs. Arch Intern Med. 2005 Apr 11;165(7):808-13. PubMed PMID: 15824303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. AU - Gill,Sudeep S, AU - Mamdani,Muhammad, AU - Naglie,Gary, AU - Streiner,David L, AU - Bronskill,Susan E, AU - Kopp,Alexander, AU - Shulman,Kenneth I, AU - Lee,Philip E, AU - Rochon,Paula A, PY - 2005/4/13/pubmed PY - 2005/5/6/medline PY - 2005/4/13/entrez SP - 808 EP - 13 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 165 IS - 7 N2 - BACKGROUND: The prescribing cascade model involves the misinterpretation of an adverse reaction to 1 drug and the subsequent, potentially inappropriate prescription of a second drug. We present a new example of the prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs used to manage urinary incontinence. METHODS: A population-based retrospective cohort study was carried out in Ontario, Canada. Participants included 44,884 older adults with dementia (20,491 were dispensed a cholinesterase inhibitor and 24,393 were not), enrolled between June 1, 1999, and March 31, 2002. Subjects were observed until they received an anticholinergic drug, stopped the cholinesterase inhibitor treatment, died, or the study period ended (March 31, 2003). The main outcome measure was receipt of an anticholinergic drug to manage urinary incontinence. RESULTS: After adjusting for potential confounding factors, we observed that older adults with dementia who were dispensed cholinesterase inhibitors had an increased risk of subsequently receiving an anticholinergic drug (4.5% vs 3.1%; P<.001; adjusted hazard ratio, 1.55; 95% confidence interval, 1.39-1.72), relative to those not receiving cholinesterase inhibitors. This finding was consistent in a series of subgroup analyses. CONCLUSIONS: Use of cholinesterase inhibitors is associated with an increased risk of receiving an anticholinergic drug to manage urinary incontinence. The use of an anticholinergic drug in this setting may represent a clinically important prescribing cascade. Clinicians should consider the possible contributing role of cholinesterase inhibitors in new-onset or worsening urinary incontinence and the potential risk of coprescribing cholinesterase inhibitors and anticholinergic drugs to patients with dementia. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15824303/A_prescribing_cascade_involving_cholinesterase_inhibitors_and_anticholinergic_drugs_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.165.7.808 DB - PRIME DP - Unbound Medicine ER -