Polypharmacy: A general review of definitions, descriptions and determinants

Guillot, Jordan; Maumus-Robert, Sandy; Bezin, Julien

doi:10.1016/j.therap.2019.10.001

Cited by 61 publications

(55 citation statements)

References 54 publications

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“…In general polypharmacy is defined to use five or more therapeutic agents for treating certain illness under indication, 26 however, the specific criteria of APP yet not yet clearly been established. According to the recent study, it was found that APP was mostly defined simply as the use of two or more APs for treatment of schizophrenia.…”

Section: Why Do Clinicians Utilize App In Routine Practice?mentioning

confidence: 99%

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Pae

2020

Chonnam Med J

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Antipsychotics have been utilized as the standard treatment for schizophrenia regardless of illness phase where antipsychotic monotherapy (APM) is routinely recommended as the gold standard rather than antipsychotic polypharmacy (APP). However, approximately 20 to 40% of patients with schizophrenia do not respond to APM based on randomized controlled clinical trials and large practical clinical trials indicating that the subgroup of patients with schizophrenia would need differential treatment approaches beyond traditional treatment strategies such as APM. Numerous studies have supported the use of APP in particular for patients with certain clinical situations including: failure to show efficacy or tolerability from treatment with APM, need for different treatment for targeting specific symptom domains, severe illness, failure to treatment with clozapine, skepticism about following treatment guidelines, or cross titration periods. Furthermore, recent large cohort studies and practical clinical trials have proposed more benefits of APP rather than APM in terms of rehospitalization, mortality, and specific symptoms. APP has recently become more widely utilized and recognized as one of the next treatment strategies to clinicians for patients with schizophrenia. Some experts have already proposed the revision of treatment guidelines incorporating APP as evidence-based treatment option for certain patients with schizophrenia. Taken together, APP now deserves an evidence-based and acceptable treatment strategy, not an empirical or preferential treatment approach for treatment of schizophrenia in contemporary clinical practice.

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Section: Why Do Clinicians Utilize App In Routine Practice?mentioning

confidence: 99%

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Pae

2020

Chonnam Med J

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“…Multimorbidity is highly prevalent in our aging societies and it often leads to the use of multiple medications in older patients [1][2][3][4][5]. There are also a number of other factors which are associated with an increased use of drugs in older people such as the wider and growing availability of effective medications in developed countries, and the numerous guidelines that encourage the use of multiple drugs for the management of common diseases [4,6,7]. While there is still no consensus on what should be regarded as polypharmacy, there are ongoing efforts to improve its definition and shift the focus from the mere number of drugs to their appropriateness, effects and, ultimately, to related clinical outcomes in older patients [6,8].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

2021

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Background The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. Methods The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. Results One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. Conclusion The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.

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“…Multimorbidity is, nowadays, common and increases with age [ 1 ]. Polypharmacy, defined as the simultaneous use of many drugs, is linked to multimorbidity and is thus consistently rising, especially in the elderly [ 2 , 3 , 4 ]. While less studied, multimorbidities and their accompanying polypharmacy are already highly prevalent in middle-aged individuals [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…While less studied, multimorbidities and their accompanying polypharmacy are already highly prevalent in middle-aged individuals [ 5 ]. Though potentially motivated by the therapeutic management of coexisting diseases, polypharmacy, which is usually defined as the concomitant use of five drugs or more [ 4 , 6 ], is associated with harmful events such as hospitalizations, falls, and even death [ 7 ]. Ensuring that polypharmacy is limited to what is needed for patients’ best care is thus an important challenge.…”

Section: Introductionmentioning

confidence: 99%

The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy

Guillot

Maumus-Robert

Marceron

et al. 2020

JCM

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We aimed to describe the burden represented by potentially inappropriate medications (PIMs) in chronic polypharmacy in France. We conducted a nationwide cross-sectional study using data from the French National Insurance databases. The study period was from 1 January 2016 to 31 December 2016. Chronic drug use was defined as uninterrupted daily use lasting ≥6 months. Chronic polypharmacy was defined as the chronic use of ≥5 medications, and chronic hyperpolypharmacy as the chronic use of ≥10 medications. For individuals aged ≥65 (older adults), PIMs were defined according to the Beers and Laroche lists, and for individuals aged 45–64 years (middle-aged) PIMs were defined according to the PROMPT (Prescribing Optimally in Middle-aged People’s Treatments) list. Among individuals with chronic polypharmacy, 4009 (46.2%) middle-aged and 18,036 (64.8%) older adults had at least one chronic PIM. Among individuals with chronic hyperpolypharmacy, these figures were, respectively, 570 (75.0%) and 2544 (88.7%). The most frequent chronic PIM were proton pump inhibitors (43.4% of older adults with chronic polypharmacy), short-acting benzodiazepines (older adults: 13.7%; middle-aged: 16.1%), hypnotics (6.1%; 7.4%), and long-acting sulfonylureas (3.9%; 12.3%). The burden of chronic PIM appeared to be very high in our study, concerning almost half of middle-aged adults and two-thirds of older adults with chronic polypharmacy. Deprescribing interventions in polypharmacy should primarily target proton pump inhibitors and hypnotics.

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Polypharmacy: A general review of definitions, descriptions and determinants

Cited by 61 publications

References 54 publications

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy

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