[Dysphagia] medication effects on swallowing

[pasekoffde at upmc.edu (Pasekoff, Deanna)]

Years ago I worked in a hospital with a large behavioral health program.
We noted that patients on large doses of Neurontin often presented with
severe dysphagia.  The literature on the medication noted dysphagia as
an extremely rare side effect 

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Irene Campbell-Taylor
Sent: Monday, October 03, 2005 2:54 PM
To: HAL9600@aol.com; scott-dailey@uiowa.edu; dysphagia@b9.com
Subject: Re: [Dysphagia] medication effects on swallowing

While it is true that pharmacists are more knowledgeable about side
effects and their input is invaluable, they are not more knowledgeable
about the direct effects of many medications - not just antipsychotics-
on the ability to swallow. They are not familiar with the literature and
they don't have the training to be able to interpret such side effects
as EPS, ataxia etc as potential issues re oropharyngeal swallowing. If
you ask the average pharmacist about medications and swallowing they
will go immediately to the important but not directly related topic of
esophageal effects of medications about which they know a great deal.
However, they are not aware of the oropharyngeal effects. 
There are many articles on the effects of neuroleptics on children and
adults with DD and as far as TBI is concerned I would suggest that it is
logical to assume that deleterious effects might be more often found in
neurologically vulnerable persons. Some articles are:
 

 Elovic EP; Lansang R; Li Y; Ricker JH The use of atypical
antipsychotics in traumatic brain injury. J Head Trauma Rehabil 2003
;18:177-95   

 
Mizoguchi Y; Monji A; Isayama H; Tashiro N  Risperidone and refusal to
eat after traumatic brain injury. J Neuropsychiatry Clin Neurosci 2002
;14(1):87-8   (induced anorexia)


 

Pourcher E; Baruch P; Bouchard RH; Filteau MJ; Bergeron D Neuroleptic
associated tardive dyskinesias in young people with psychoses. Br J
Psychiatry 1995 ;166(6):768-72 

and there are many more.


HAL9600@aol.com wrote:
Is there any literature of which you are aware studying effects of
anti-psychotics on swallowing of brain injured individuals?

Gerry Brooks
--
Gerry Brooks, MA, CCC, CBIT
Brain Injury Program Director
Northeast Center for Special Care
Lake Katrine, New York 12449
northeastcenter.com


In a message dated 10/3/05 12:50:58 PM Eastern Daylight Time,
scott-dailey@uiowa.edu writes:

<< Subj: RE: [Dysphagia] medication effects on swallowing
Date: 10/3/05 12:50:58 PM Eastern Daylight Time
From: scott-dailey@uiowa.edu (Dailey, Scott)
Sender: dysphagia-bounces@b9.com
To: eripley@yahoo.com (Irene Campbell-Taylor), dysphagia@b9.com

Similarly, the effects with developmentally disabled individuals are not
widely known either. On another note, there is little documentation of
the possible interactions between medications when a person is on
multiple, multiple meds. (medications for the side effects of other
medications). It is always a good idea to find a good pharmacist who can
help review medication lists when your own searches have not offered
much info. In my experience the pharmacists have more extensive
knowledge of the side effects than do the prescribing physicians (this
is not always the case, some physicians are excellent in regard to this)

Scott

Scott Dailey, M.A., CCC-SLP
Speech-Language Pathologist II
University of Iowa Hospitals & Clinics
200 Hawkins Dr
Iowa City, IA 52242
(319)356-7030

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-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of Irene Campbell-Taylor
Sent: Monday, October 03, 2005 8:58 AM
To: dysphagia@b9.com
Subject: [Dysphagia] medication effects on swallowing

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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Dr I Campbell-Taylor
Clinical Neuroscientist
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www.interactivetherapy.com
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