Concomitant Use of Cholinesterase Inhibitors and Anticholinergics

Patients with dementia sometimes receive both cholinesterase inhibitors (e.g., donepezil [Aricept and generics]) and anticholinergic drugs (e.g., bowel and bladder antispasmodics, antihistamines with anticholinergic properties). However, these two drug classes have opposing biochemical effects. To determine the prevalence of concomitant use of these agents, researchers analyzed databases from two large U.S. integrated healthcare delivery systems.

Of 5625 patients who used cholinesterase inhibitors, 37% received one or more anticholinergic drugs simultaneously. The median duration of overlapping use was 4 months. Nearly a quarter of patients already were taking an anticholinergic drug when the cholinesterase inhibitor was initiated; in these …