Widely used drugs linked to falls and frailty in older people living with HIV

According to a study presented to Conference on Retroviruses and Opportunistic Infections (CROI 2022).

Anticholinergic drugs block acetylcholine, a neurotransmitter that relays signals from nerves to muscles and organs. This class of drugs includes prescription and over-the-counter medications used to treat asthma, psychiatric disorders, overactive bladder, gastrointestinal problems, allergies, and more. Examples include codeine (used to manage pain and cough) and the commonly used antihistamine Benadryl (diphenhydramine). Well-known anticholinergic side effects include dry mouth and eyes, constipation, and decreased mental alertness. Other potential side effects include cognitive impairment, reduced muscle control, and poor coordination. These medications have been linked to falls and frailty in the elderly in the general population, and some experts recommend limiting their use in the elderly.

Jessica Doctor, MD, of Guy’s and St. Thomas’ Hospital in London, and colleagues examined the association between anticholinergic drug use and falls and frailty in HIV-positive people over the age of 50. The analysis included 699 participants from POPPY study, a large study of clinical outcomes in older people living with HIV in England and Ireland. Most were white males, with a median age of 57. Almost all were on antiretroviral therapy and about 90% had an undetectable viral load and an adequate CD4 count (greater than 350 cells).

Within this study population, 193 people (27%) reported using drugs with anticholinergic effects, including 64 (9%) who took two or more of these drugs. Most frequently used were codeine, citalopram (Celexa and generics, for depression), loperamide (for diarrhea), and amitriptyline (Elavil and generics, for depression), used by 7% to 12% of participants . People who used anticholinergics had more comorbidities, took more drugs overall, were more likely to use recreational drugs, and were more likely to suffer from depression.

Overall, 9% of the study population reported recurrent falls (at least two in the past month) and 21% met criteria for frailty (including poor grip strength, walking speed sluggishness, exhaustion due to fatigue and reduced activity).

The researchers found that 17% of people who used anticholinergic drugs reported having recurrent falls, compared to 6% of those who did not use these drugs. The use of two or more anticholinergics increased the risk of falls after adjusting for other factors. Frailty was also more common among anticholinergic users, at 32% versus 17%.

“There is strong evidence for an association between cumulative use of anticholinergic medications and recurrent falls, and to a lesser extent frailty,” the researchers concluded. “Clinicians should be alert to this association and reduce exposure to anticholinergic drugs whenever possible.”

Click here to read the study summary.
Click here for more CROI 2022 reports.

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