Use of acetylcholinesterase inhibitors: length of treatment, sex differences and comedication with focus on psychotropics, analgesics and heart rate related drugs

Comedication with psychotropics and analgesics in patients treated with acetylcholinesterase inhibitors (AChEIs) was studied prior to- and after start of AChEIs which was a surrogate measure of the dementia diagnosis due to Alzheimer’s disease. Data from the Norwegian Prescription Database was used. Co-prescribing with potentially unfavourable medications like anticholinergic agents that may counteract or limit the clinical effect of the AChEI was common. Patients being prescribed antipsychotics were more likely to stop AChEI treatment early. The use of antidepressants and antipsychotics increased before and after initiation of AChEIs, indicating that behavioural and psychological symptoms of dementia occur in an early- or preclinical phase of Alzheimer´s disease. A low use of opioids may indicate an undertreatment of pain. Women were prescribed more psychotropics and analgesics than men, except for antipsychotics, and were more often subjected to polypharmacy. A large proportion of the patients were prescribed drugs that have the potential to increase heart related adverse effects of the AChEIs, like bradycardia. Inappropriate drugs should be avoided in patients in a predementia or dementia stage, especially in the oldest age groups. Pain should be detected and treated as early as possible. Co-prescribing of drugs which could increase heart related adverse effects of the AChEI should be monitored closely