Evidence map›Paper›PMID 22372724›Full record

ArticleDrugs & aging2012

Use of clarithromycin and adverse cardiovascular events among older patients receiving donepezil: a population-based, nested case-control study.

Janine R Hutson, Hadas D Fischer, Xuesong Wang, Andrea Gruneir, Nick Daneman, Sudeep S Gill, Paula A Rochon, Geoffrey M Anderson

Abstract read
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In one paragraph

Article in Drugs & aging, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
0.8field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 1 country.

Janine R HutsonFaculty of Medicine, University of Toronto, Toronto, ON, Canada. j.hutson@utoronto.ca.
Hadas D FischerSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Xuesong WangSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Andrea GruneirSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Nick DanemanSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Sudeep S GillSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Paula A RochonFaculty of Medicine, University of Toronto, Toronto, ON, Canada.
Geoffrey M AndersonSunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Health Sciences Centre · CAInstitute for Clinical Evaluative Sciences · CAUniversity of Toronto · CAQueen's University · CASunnybrook Health Science Centre · CA

Funding

Canadian Institutes of Health Research HOA-80075Canadian Institutes of Health Research OTG-88591
6 · The paper itself

Abstract

backgroundDonepezil is a commonly used drug in older people that due to its procholinergic effects can provoke bradycardia and neurocardiogenic syncope. Donepezil is metabolized by the cytochrome P450 isozyme 3A4 (CYP3A4). Clarithromycin is a potent inhibitor of CYP3A4, and patients taking both of these drugs may be at increased risk of cardiac adverse events.

objectiveThe aim of this study was to evaluate the association between recent use of clarithromycin and adverse cardiovascular events in elderly patients receiving donepezil.

methodsA population-based, nested case-control study using provincial healthcare databases was conducted. The base cohort was made up of persons 66 years of age or older who were prescribed donepezil and also were prescribed clarithromycin, erythromycin, azithromycin, cefuroxime, moxifloxacin or levofloxacin. Cases were those members of the base cohort hospitalized for bradycardia, syncope or complete atrioventricular block. For each case patient, five controls were matched according to age, sex and residence (community or long-term care).

resultsBetween July 2002 and March 2010, 17,712 patients continuously receiving donepezil were prescribed one of the antibacterials. In 1400 person-years of follow-up, 59 cases were identified. As compared with azithromycin, there was no statistically significant association between use of clarithromycin in donepezil users and subsequent adverse cardiovascular events (odds ratio 0.67; 95% CI 0.28, 1.63). There was no significant risk associated with exposure to either cefuroxime or respiratory quinolones.

conclusionsThe use of clarithromycin in elderly donepezil users did not significantly increase the risk of adverse cardiovascular outcomes. However, our study cannot rule out a possible small increase in risk. Although antibacterials can be beneficial, care should be taken in selecting antibacterials for use in older people receiving donepezil.

Indexed as

Cytochrome P-450 CYP3A InhibitorsAgedAged, 80 and overAnti-Bacterial AgentsAtrioventricular BlockBradycardiaCardiovascular DiseasesCase-Control StudiesCholinesterase InhibitorsClarithromycinCohort StudiesDonepezilDrug InteractionsDrug PrescriptionsEnzyme InhibitorsFemaleAnti-Bacterial AgentsCholinesterase InhibitorsClarithromycinCytochrome P-450 CYP3A InhibitorsDonepezilEnzyme InhibitorsIndansMacrolidesPiperidines

Identifiers

PMID22372724
OpenAlexW1238745791

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.