Trends of Concurrent Use of Anticholinergics with Antipsychotics, And the Associated Factors for the Current Practice

Bwalya FT, Mwanza J and Paul R

Published on: 2022-09-07

Abstract

Introduction: Anticholinergic drugs have been used concurrently with antipsychotics to treat or as prophylaxis for extrapyramidal side effects (EPS) in patients at risk. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for EPS to patients on antipsychotic drugs. Anticholinergics can cause significant central and peripheral side effects which can affect treatment outcomes. The study assessed whether prescribers were adhering to treatment guidelines with regards to the concomitant use of anticholinergic and antipsychotic drugs.

Methodology: A cross sectional study was conducted at a tertiary psychiatric hospital in Zambia. 311 charts of patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute of Clinical Excellence (NICE) guidelines as a gold standard.

Results: Only 9% of patients on anticholinergics had an anticholinergic commenced when they developed EPS.83.1% of the patients on anticholinergics had been prescribed concomitantly with an antipsychotic with no evidence or documentation to support the use of the anticholinergic drug.The dose of anticholinergics was correct in 42.0% of the patients. There was no significant correlation between patient regimen adherence to guidelines with either age or sex, Sig. 2 tailed of 0.358 and 0.100 respectively. There was no significant correlation between patient regimen adherences to guidelines with when/reason patient started anticholinergics, Sig. 2 tailed of 0.605.

Conclusion: The study concluded that poor adherence to recommended guidelines on the prescribing of anticholinergics exists. The prescribing pattern of antipsychotics have an effect on anticholinergic prescribing. There is need for clinicians to be guided on the recommended standard practice of anticholinergic prescribing with antipsychotics.