Exploring Concomitant Acetylcholinesterase Inhibitor and Overactive Bladder Anticholinergic Use and Risk of Hospitalization in Medicare and Dual-Eligible Medicare-Medicaid Populations in a Historic Database

Jonathan H Watanabe; Tu Hoang

doi:10.3390/pharmacy11050140

Exploring Concomitant Acetylcholinesterase Inhibitor and Overactive Bladder Anticholinergic Use and Risk of Hospitalization in Medicare and Dual-Eligible Medicare-Medicaid Populations in a Historic Database

Pharmacy (Basel). 2023 Sep 7;11(5):140. doi: 10.3390/pharmacy11050140.

Authors

Jonathan H Watanabe¹, Tu Hoang²

Affiliations

¹ Center for Data-Driven Drugs Research and Policy, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, 856 Health Sciences Quad Drive, Suite 5400, Irvine, CA 92697, USA.
² School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, 856 Health Sciences Rd., Irvine, CA 92697, USA.

Abstract

Overactive bladder prevalence increases in older adults often complicating the management of other comorbidities. The theoretical antagonism between the parasympathetic-blocking anticholinergic agent and the parasympathetic stimulatory agents concomitantly used by patients is only recently being explored. The primary aim was to determine the frequency of the annual use of acetylcholinesterase inhibitors, overactive bladder anticholinergics, and the use of both agents in the same year. The secondary aim was measurement of the association between annual hospitalization and same-year use of both acetylcholinesterase inhibitors and anticholinergics. The US nationally representative MarketScan^® Medicare databases were analyzed. In the Medicare enrollees, there were 122 020, 141 920, and 15 639 users of acetylcholinesterase inhibitors, anticholinergics, and both agents, respectively. The percentage of acetylcholinesterase inhibitor users who also used anticholinergics was 12.8%. Comparing users of both acetylcholinesterase inhibitors and anticholinergics to those using AChEI alone, 5 608 of the former experienced a hospitalization (35.9%) compared to 33 182 of the latter (31.2%). There was an increased risk of hospitalization for those using both acetylcholinesterase inhibitors and anticholinergics in the same year, with an odds ratio (OR) of 1.23 (95% CI, 1.19, 1.28). Clinicians should consider improved monitoring of the usage of both medications and clarify alternative regimens that avoid anticholinergics in at-risk older adults.

Keywords: Alzheimer’s disease; acetylcholinesterase inhibitors; anticholinergics; antimuscarinics; dementia; overactive bladder.

Grants and funding

J.H.W. received partial funding support from the National Academy of Medicine (NAM) Anniversay Pharmacy Fellowship during the initiation of this project. The NAM did not have any role in the design, methods, analysis, or preparation of this manuscript. The information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the National Academy of Medicine.