GPs warned over cumulative effect of polypharmacy in over-65s

GPs must be wary of the cumulative impact on over-65s being prescribed multiple drugs inhibiting acetylcholine, UK researchers have said.

Drugs which inhibit acetylcholine on cognition increases the cumulative risk of cognitive impairment and mortality in over-65s (Photograph: Jim varney)
Drugs which inhibit acetylcholine on cognition increases the cumulative risk of cognitive impairment and mortality in over-65s (Photograph: Jim varney)

Dr Chris Fox and colleagues from the University of East Anglia looked at the effect of drugs which inhibit acetylcholine on cognition in 13,004 people aged over 65 years. Inhibition of acetylcholine is a known potential side effect of many prescription and OTC drugs

The researchers found that the use of such medicines increase the cumulative risk of cognitive impairment and mortality. In the study, 48% of patient reported taking drugs with such anticholinergic properties.

Dr Fox and his team concluded: ‘With a growing prevalence of cognitive impairment in the older adult population, prescribers should be aware of the potential effect that anticholinergics have on the development of cognitive and executive dysfunction and mortality.’

Medicines which inhibit acetylcholine to some degree include anti-depressants (eg, amitriptyline), tranquilisers (eg, chlorpromazine and trifluoperazine) and antihistamines (eg, chlorphenamine). Others include atenolol, furosemide, codeine, beclometasone, carbamazepine and timolol.

Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said the ‘robust' study provided valuable findings and must be taken seriously. ‘However it is vital that people do not panic or stop taking their medication without consulting their GP,’ she said.

‘We would urge people to have regular appointments with their doctor to review all drug treatments they are taking. This will help ensure they are on the best medications for their conditions, and that any side effects have been taken into consideration.’

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