Avoiding Anticholinergic Burden in Patients With Movement Disorders

Authors of a recent study report more education is needed on the appropriate usage of anticholinergic medications among older adults (OAs) with movement disorders.

Researchers conducted an expert roundtable, in addition to a health care professional (HCP) survey and a study focused on health care economics and outcomes research (HEOR) with the goal of describing appropriate anticholinergic usage for treating some drug-induced movement disorders in OAs. 

“Treating [drug-induced movement disorders] in elderly patients, who have a higher risk for tardive dyskinesia, can be challenging due to multiple comorbidities, polypharmacy, and greater susceptibility to serious anticholinergic -related adverse events (eg, cognitive difficulties),” said researchers. 

The 9 movement disorder and/or mental health experts who comprised the expert roundtable agreed on the following:

• more education is needed on drug-induced movement disorder differentiation;
• anticholinergics are “not generally recommended” for OA patients; and
• patients who plan to discontinue use of anticholinergic medications should taper usage rather than abruptly stop. 

A total of 349 primary care or psychiatric physicians and nurse practitioners or physician assistants (NP-PA) completed a 30-minute, internet-based, double-blinded survey on the use of benztropine to treat or prevent drug-induced movement disorders. 

Per results of the survey, “39%/41% of psychiatry HCPs (physician/NP-PA) and 80%/65% of primary care HCPs reported using benztropine to treat tardive dyskinesia. Moreover, 37%/34% of psychiatry HCPs (physician/NP-PA) and 68%/52% of primary care HCPs reported being ‘somewhat’ or ‘extremely’ likely to treat elderly patients with an AC.”

Respondents also reported interested in additional education regarding benztropine discontinuation, anticholinergic dose tapering, and differential drug-induced movement disorders diagnosis via telehealth.

Lastly, in the HEOR analysis of 112,542 patients who had recent exposure to antipsychotics and a new benztropine pharmacy claim, 59% of patients were already taking ≥10 unique medications with 88% taking ≥1 medication with anticholinergic properties. 

Additionally, a reported 31% of patients aged ≥65 years were taking medications associated with severe anticholinergic burden, which can potentially impact inpatient admission and health care costs. 

“More education on appropriate anticholinergic use is warranted, especially in [OA] patients in whom unnecessary anticholinergic burden should be avoided to reduce the risk of serious side effects,” concluded authors. 

Reference:
Bron M, Chepke C, Vanegas-Arroyave N, Cicero S. Use of anticholinergics for drug-induced movement disorders with implications for elderly patients. J Manag Care Spec Pharm. 2023;29(10-a suppl):S1-S137. https://www.jmcp.org/pb-assets/Poster%20Abstract%20Supplements/AMCP2023_PosterAbstractSupplement_0317-1679318682267.pdf