[Dysphagia] medication effects on swallowing

[eripley at yahoo.com (Irene Campbell-Taylor)]

For over twenty five years I have been trying to get physicians to recognize that certain medications, especially in the elderly, have a direct deleterious effect on the ability to swallow. When I first pointed out the relationship between antipsychotics and parkinsonism leading to deglutition disturbance, I was told that "there was no such evidence in the psychaitric literature" even though there certainly was. I'm gald to say that, by now, the effects are somewhat better identified although still far from widely known. The recent argument has been that the newer "atypical" antipsychotics do not have these effects although clinically and by report they certainly do. The latest, large study, just released, confirms this. I urge all who work with the elderly to pay particular attention not only to antipsychotic use but to medications in general as the cause of your patients' swallowing impairment, especially thise who are diagnosed as "dementing."
Please see:

Atypical Antipsychotics Raise the Risk of Parkinsonism

NEW YORK (Reuters Health) Sept 30 - Atypical antipsychotics, especially when given in higher doses, significantly increase the risk of parkinsonism, Canadian researchers report in the September 12th issue of Archives of Internal Medicine. The risk, they say, may be no less than that with the older typical antipsychotics.

In fact, lead investigator Dr. Paula A. Rochon told Reuters Health that "physicians may have been optimistic that these drugs don't have side effects, but we are finding out that they do. And they are dose related. We need to think about whether we need the drug at all and, if so, reassess the dose."

Dr. Rochon of Baycrest Centre for Geriatric Care, Toronto and colleagues investigated the potential association between exposure and the subsequent development of parkinsonism with atypical relative to typical antipsychotics in more than 25,000 elderly patients with dementia.

Compared to patients treated with atypical antipsychotics, the authors report, patients given typical antipsychotics were 30% more likely to develop parkinsonism. Patients not treated with antipsychotics were 60% less likely than those given atypical antipsychotics to develop parkinsonism.

There was no difference in the incidence of parkinsonism between patients treated with atypical antipsychotics and those given lower-potency typical antipsychotics.

However, among patients treated with atypical antipsychotics, the researchers note, those given a high-dose agent were more than twice as likely as those given a low-dose agent to develop parkinsonism. Moreover, patients dispensed a high-dose atypical antipsychotic were at a similar risk for parkinsonism as patients dispensed a typical antipsychotic.

Given these findings, Dr. Rochon concluded by noting that when atypical antipsychotics are being used, "it's always worth considering whether our patients still need that dose or whether it could be decreased."

Arch Intern Med 2005;165:1882-1888

 



Dr I Campbell-Taylor
Clinical Neuroscientist
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