Letter to the Editor Regarding the Article: “Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward”

Alves, Mariana; Narciso, Marco; Fonseca, Teresa; Clara, J. Gorjão

doi:10.20344/amp.12078

Cited by 3 publications

(3 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lorazepam, mainly prescribed in primary care, is an intermediate-acting, high potency BZD reported to be a significant predictor of long-term BZD use, dose escalation or heavy use (Kurko et al, 2015 ). Considering that lorazepam is included in the EU(7)-PIM list adapted to Portugal, and also in the most recent updates of both Beers and STOPP and START criteria (2023 American Geriatrics Society Beers Criteria® Update Expert Panel, 2023 ; O’Mahony et al, 2023 ), identifying potentially inappropriate medicines in older patients (Rodrigues et al, 2020 ) who are more susceptible to suffer from BZDR adverse effects (Gomes et al, 2023 ; Madeira et al, 2023 ; Prazeres, 2023 ), and that most ARSLVT lorazepam users are older patients – 53.7% of our chronic lorazepam users were aged 65 or more – the lorazepam chronic use found in our study is a cause for concern. Besides lorazepam, our results have also shown that analgesic buprenorphine and tramadol + paracetamol users are the oldest PMed users (mean 73.6 and 71.5 years, respectively).…”

Section: Discussionmentioning

confidence: 99%

Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal

Carmona Araújo,

Guerreiro,

Bulhosa

et al. 2024

Journal of Pharmaceutical Policy and Practice

View full text Add to dashboard Cite

Introduction Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse. Methods Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines’ dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed. Results PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators – fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone. Conclusions BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.

show abstract

Section: Discussionmentioning

confidence: 99%

Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal

Carmona Araújo,

Guerreiro,

Bulhosa

et al. 2024

Journal of Pharmaceutical Policy and Practice

View full text Add to dashboard Cite

show abstract

“…4,5 Finally, we would like to highlight that hospitalization should also be an opportunity to review polymedication and inappropriate prescribing, which frequently includes drugs inappropriately used to manage sleep disturbance. 6,7…”

Section: Dear Editormentioning

confidence: 99%

Sleep Disturbances Management in Elderly Hospitalized Patients

Alves

Macedo

Távora

et al. 2021

Journal of Pharmacy Practice

Self Cite

View full text Add to dashboard Cite

“…Dear Editor, We read with interest an article about inappropriate prescribing to elderly patients in an internal medicine ward 1 and a letter to the editor regarding the same paper. 2 We developed a similar study in the Portuguese primary care setting with a nation-wide representative sample of 757 elderly patients in accordance to its distribution in Portuguese health regions and we found that 77% of them were on ≥ 5 medications (with a mean of 8.2) and that 68% had at least one potentially inappropriate medication according the to 2015 Beers Criteria (with a mean of 1.72). The most common potentially inappropriate pharmacological classes were proton pump inhibitors (45.6%), non-steroid anti-inflammatory agents (34.5%) and benzodiazepines (27.3%).…”

mentioning

confidence: 99%