title: Atropinic burden of prescriptions forms in patients with Alzheimer disease: a cross-sectional study in a French PharmacoVigilance Database.
abstract: OBJECTIVE
  Atropinic drugs in patients with Alzheimer disease (AD) can decrease the effects of anticholinesterase drugs and/or induce adverse drug reactions (ADRs). Several atropinic risk scales defining an atropinic burden of drugs were proposed but were little used in AD patients.
  
  
  METHODS
  All ADRs' notifications of AD patients registered in the Midi-Pyrénées PharmacoVigilance Database between 1999 and 2013 were analyzed using Anticholinergic Drug Scale (ADS) and Anticholinergic Duran's list. The primary objective was to quantify atropinic burden in AD patients and the secondary one to investigate associated factors.
  
  
  RESULTS
  Among the 475 notifications, at least one atropinic drug was found in 282 notifications (59.4%) according to ADS and 214 (45.1%) according to Duran. Mean number of atropinics per notifications was 0.9 ± 0.9 (ADS) and 0.7 ± 0.9 (Duran). Mean atropinic burden per notifications was 1.2 ± 1.5 (ADS) and 0.9 ± 1.3 (Duran). Atropinic burden ≥ 3 was found in 87 notifications (18.2%) according to ADS and 50 (10.5%) according to Duran. There was no association between atropinic burden and age of patients. The number of drugs is associated to a high atropinic burden.
  
  
  CONCLUSIONS
  The present work found an association between an atropinic drug and an anticholinesterase agent in around 1 out of 2 AD patients and a clinically significant atropinic burden (≥ 3) in around 1 to 2 AD patients out of 10. The benefit harm balance of atropinic drugs must be discussed before each prescription in AD patients.
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Information sur le Médicament, Equipe de Pharmacoépidémiologie de l'UMR INSERM 1027, Faculté de Médecine de l'Université Paul-Sabatier et Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Montastruc
authors.forename: Sarah
authors.initials: S
authors.lastname: Rouanet
authors.forename: Virginie
authors.initials: V
authors.lastname: Gardette
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rousseau
authors.forename: Haleh
authors.initials: H
authors.lastname: Bagheri
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Montastruc
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004347:Drug Interactions; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D005602:France; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D061214:Patient Safety; D060735:Pharmacovigilance; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D002800:Cholinesterase Inhibitors; D018727:Muscarinic Antagonists