Anticholinergic drugs cardiovascular risks

Cardiovascular Among 82717 US veterans with a new diagnosis of COPD, who were followed until they had their first hospitalization for a cardiovascular event, or died, or reached the end of the study period, there were 6234 cardiovascular events (44% heart failure, 28% acute coronary syndrome, and 28% cardiac dysrhythmias) [27. The risk of cardiovascular events was increased in those who had used ipratropium in the past 6 months (HR=1.40 95% Cl = 1.3, 1.5). Among those who had used an anticholinergic drug more than 6 months before, there did not appear to be an increased risk of a cardiovascular event. This study was limited, owing to incomplete hospital admission data and lack of data on cardiovascular risk factors and severity of COPD. 

The risk of adverse cardiovascular events during the use of inhaled anticholinergic drugs was reviewed in SEDA-32 (p. 318). Further information has come to light in this controversial area. 

Tiotropium A potential association with cardiovascular risk has been suggested for long-acting anticholinergic drugs. In a 2-year randomized controlled study of the benefits of tiotropium versus fluticasone and salmeterol in 1323 patients with severe COPD, tiotropium was associated with significantly increased mortality (3% versus 6%), with an increase in cardiac events [86 ]. However, in a case series that specifically studied stroke in relation to tiotropium, there was no association [87 ]. 

Long-term safety of long-acting beta2-adrenoceptor agonists (LABAs)—an update 357 Cardiovascular risks of inhaled anticholinergic drugs 364... 

Anthracyclines, 25.533 Antiallergic drugs, ocular treatment, 11.420 Antibacterial drugs, resistance, 31.413, 32.445 intrapartum, 32.446 Anticancer antimetabolites, 29.531 Anticholinergic drugs, 22.507, 31.273 cardiovascular risks, 32.318 Anticoagulants, oral, skin necrosis, 29.358... 

A number of medications have been associated with an increased risk of falling, including drugs affecting mental status such as antipsychotics, benzodiazepines, tricyclic antidepressants, sedative-hypnotics, anticholinergics, and corticosteroids. Some cardiovascular and antihypertensive drugs also can contribute to falls, especially those causing orthostatic hypotension.9... 

Clozapine, which is associated with higher risk of agranulocytosis and seizures, is indicated (25 mg once or twice daily) only in the management of schizophrenic patients who fail to respond adequately to standard antipsychotic drug treatment. On the other hand, it is relatively free from extrapyramidal side effects such as parkinsonism. Approximately 50% of the administered dose is excreted in the urine and 30% in the feces as inactive demethylated, hydroxylated, and N-oxide derivatives. Clozapine has anticholinergic properties and causes tachycardia, and hence poses a serious risk for a patient with compromised cardiovascular function (see also Table 23). 

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