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KMID : 0869620220390020174
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Journal of Korean Society of Hospital Pharmacists
2022 Volume.39 No. 2 p.174 ~ p.184
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Evaluation of the Effectiveness of Atropine Administration for Prevention of Acute Cholinergic Syndrome Associated with Irinotecan
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Choi You-Ock
Jo Eun-Ah
Lee So-Hee
Park Ae-Ryoung
Yoon Jeong-Yi
Kang Jin-Suk
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Abstract
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Background : Acute cholinergic syndrome frequently occurs during or shortly after administration of irinotecan. There are few studies on the efficacy of atropine pre-treatment for primary preventive purposes in patients untreated with irinotecan. The purpose of this study was to evaluate that the appropriateness of atropine pre-treatment by comparing the incidence rate, pattern and risk factors of acute cholinergic syndrome, between atropine pretreated group and non-pretreated group in patients first injected with irinotecan.
Methods : We conducted a retrospective study of patients who were first administered irinotecan January 2018 - June 2019. We retrospectively analyzed medical records of patients who were and were not administered atropine as premedication. Primary outcome is the incidence of acute cholinergic syndrome comparing two groups, and the relationship with acute cholinergic syndrome was evaluated by gender, age, weight, body mass index (BMI), renal function level, liver function level, number of combined anticancer drugs, and atropine pre-treatment as risk factors, using logistic regression analysis.
Results : Comparison of the pretreated group (n=197) and non-pretreated group (n=79) showed that the initial incidence of acute cholinergic syndrome was 18.8% vs 38.0%, significantly higher in atropine non-pretreated groups (p=0.001). Additionally, 67 patients complained about symptoms of acute cholinergic syndrome, with diarrhea (30.7%), perspiration (25.3%) and convulsive abdominal pain (24.0%). In the analysis of risk factors related to acute cholinergic syndrome, BMI less than 17 (Odds ratio= 4.999, 95% CI 1.391-17.963, p=0.014), or additional cytotoxic anticancer drugs (Odds ratio= 5.813, 95% CI 2.642-12.791, p<0.001) increased the incidence rate.
Conclusion : The incidence of irinotecan-induced acute cholinergic syndrome at first injection decreased significantly in atropine pre-treatment group. Thus, it is expected that atropine premedication is available for primary prevention in patients previously untreated with irinotecan, and it can be suggested that atropine pre-treatment be performed in medical department who did not administer atropine in the injection of irinotecan.
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KEYWORD
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Irinotecan, Atropine, Acute cholinergic syndrome, Premedication, Anti-cholinergic agent
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