Polypharmacy, potentially serious clinically relevant drug‐drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life

AL-Musawe, Labib; Torre, Carla; Guerreiro, José; Rodrigues, António Teixeira; Raposo, João Filipe; Mota-Filipe, Hélder; Martins, Ana Paula

doi:10.1002/prp2.621

Cited by 31 publications

(37 citation statements)

References 41 publications

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“…In multi-pathological patients, where polypharmacy is so common, published studies assessing the usefulness of drug interaction screening programs are very limited [4, 5]. Our results demonstrated that in patients with that profile, discrepant results among those programs are also very common; differences among the 3 programs we assessed were so extent that comparison among them was virtually unfeasible, with the exception, perhaps, of Medscape and Drugs, where findings were partially similar.…”

Section: Discussionmentioning

confidence: 67%

“…Polypharmacy not only increases the likelihood of drug interactions and adverse drug events but also associated with drug administration errors and nonadherence [12]. Those problems may affect patients of any age, but they are particularly prevalent in the elderly, where decline in elimination organ’s function, metabolic changes, and cognitive deficit are common [2, 5, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies by now have assessed the usefulness and reliability of those programs, particularly in subjects taking polypharmacy [4, 5]. For that reason, we undertook this study, with the aim of evaluating 3 of those online tools in multi-pathological patients.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients

Roca

2021

Pharmacology

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Introduction: Multi-pathological patients are at high risk of drug interactions and side effects. We aimed to assess the usefulness of 3 online drug interaction checkers. Methods: In a cross-sectional study, carried out in the Medicine Department of Hospital General of Castellon, Spain, in February 2020, we assessed drug interaction detection with 3 online electronic checkers, Drugs.com, Lexicomp®, and Medscape, and compared results obtained with the 3 tools. From every hospitalized patient, we obtained the list of drugs he or she had been taking until admission. Bivariable tests were used for analysis. p values <0.05 were considered significant. Results: We included data from 134 patients; 68 (51%) were male; median (and interquartile range) of their age was 82 (76–88) years. A total of 1,082 substance drugs were entered in the checkers. The number of highest grade interactions found with every program was Drugs.com 85, Lexicomp® 33, and Medscape 67. Positive correlations were found between age and number of drug substances prescribed (p = 0.009) and between number of drug substances prescribed and interactions found with any of the 3 checkers (p < 0.001 in all 3 cases). Regarding highest grade interactions, agreement among all 3 checkers was poor. Conclusions: The 3 online checkers we assessed found a large number of interactions. The 3 programs gave very discrepant results. Impact on Practice Statements: The analyzed programs, Drugs.com, Lexicomp®, and Medscape Interactions, found a large number of drug interactions in the studied patients. The 3 programs gave very discrepant results among them.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients

Roca

2021

Pharmacology

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“…The mean age of the enrolled samples was about 75 years, except for the work of McCracken et al [ 21 ], performed on older patients (mean age 85 years). Concerning the definition of polypharmacy, four studies considered the usual consumption of 5 or more medications per day [ 13 , 14 , 18 , 20 , 22 ], two studies of > 5 drugs/ day [ 17 , 19 ], one of ≥ 4 drugs/day [ 4 ], and one of ≥ 9 drugs per day [ 21 ]. One work reported the median number of medications taken, but not the frequency of polypharmacy [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

et al. 2022

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Background Polypharmacy is a prevalent condition in older adults, especially those with multiple chronic diseases, and has been largely associated with adverse outcomes, including disability, hospitalizations, and death. Aims This systematic review focused on diabetes and aimed to investigate the prevalence and impact of polypharmacy in older adults affected by such disease. Methods Observational (either cross-sectional or longitudinal) or experimental studies investigating the frequency and impact of polypharmacy in older adults with diabetes were identified from scientific databases and grey literature until August 2021. The prevalence and the 95% Confidence Interval (95% CI) of polypharmacy in older people with diabetes were summarized by a random-effects meta-analysis. Results From a total of 1465 records, 9 were selected for the qualitative synthesis, and 8 for the quantitative synthesis. Most studies defined polypharmacy using a cut-off for the minimum number of medications ranging from 4 to 6 drugs/day. The pooled prevalence of polypharmacy in older people with diabetes was 64% (95% CI 45–80%). Considering studies that used the same definition of polypharmacy (i.e. ≥ 5 drugs/day), the pooled prevalence was 50% (95% CI 37–63%). The between-studies heterogeneity was high. Across the selected studies, polypharmacy seemed to negatively influence both diabetes-specific (poor glycemic control and risk of hypoglycemia) and health-related (risk of incident falls, syncope, hospitalization, and death) outcomes. Conclusion This systematic review confirms the high prevalence of polypharmacy in older people with diabetes and its strong impact on several health-related outcomes, including mortality. These results strengthen the need to improve care strategies for management of these patients.

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“…Patients presenting with several chronic conditions such as psychiatric disorders, cardiovascular disorders, diabetes, and rheumatoid arthritis often require multiple therapeutic approaches, including the use of numerous drugs, to achieve clinical benefits and experience favorable outcomes [ 1 , 2 , 3 , 4 ]. The co-administration of multiple drugs required to treat complex conditions and associated comorbidities can lead to major pharmacokinetic and/or pharmacodynamic drug–drug interactions (DDIs) [ 5 , 6 , 7 ]. These circumstances also impact drug safety, adherence, and efficacy [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Mechanism of Fluoxetine-Mediated CYP2D6 Inhibition

et al. 2021

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Fluoxetine is still one of the most widely used antidepressants in the world. The drug is extensively metabolized by several cytochrome P450 (CYP450) enzymes and subjected to a myriad of CYP450-mediated drug interactions. In a multidrug regimen, preemptive mitigation of drug–drug interactions requires knowledge of fluoxetine actions on these CYP450 enzymes. The major metabolic pathway of fluoxetine leading to the formation of its active metabolite, norfluoxetine, is mediated by CYP2D6. Fluoxetine and norfluoxetine are strong affinity substrates of CYP2D6 and can inhibit, potentially through various mechanisms, the metabolism of other sensitive CYP2D6 substrates. Remarkably, fluoxetine-mediated CYP2D6 inhibition subsides long after fluoxetine first passes through the liver and even remains long after the discontinuation of the drug. Herein, we review pharmacokinetic and pharmacogenetic information to help us understand the mechanisms underlying the prolonged inhibition of CYP2D6 following fluoxetine administration. We propose that long-term inhibition of CYP2D6 is likely a result of competitive inhibition. This is due to strong affinity binding of fluoxetine and norfluoxetine to the enzyme and unbound fluoxetine and norfluoxetine levels circulating in the blood for a long period of time because of their long elimination half-life. Additionally, we describe that fluoxetine is a CYP2C9 substrate and a mechanism-based inhibitor of CYP2C19.

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Polypharmacy, potentially serious clinically relevant drug‐drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 31 publications

References 41 publications

Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients

Assessment of Drug Interactions with Online Electronic Checkers in Multi-Pathological Patients

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

Assessing the Mechanism of Fluoxetine-Mediated CYP2D6 Inhibition

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