Potentially inappropriate medication in older psychiatric patients

Hefner, Gudrun; Hahn, Martina; Toto, Sermin; Hiemke, Christoph; Roll, Sibylle C.; Wolff, Jan; Klimke, A.

doi:10.1007/s00228-020-03012-w

Cited by 21 publications

(38 citation statements)

References 57 publications

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“…a main diagnosis of F32 � or F33 � , ICD-10. Previous publications from this research project can be found in the reference list [10,12,14,[23][24][25][26].…”

Section: Study Samplementioning

confidence: 99%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

et al. 2021

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Introduction The aim of this study was to describe the number and type of drugs used to treat depressive disorders in inpatient psychiatry and to analyse the determinants of potential drug-drug interactions (pDDI) and potentially inappropriate medication (PIM). Methods Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019. Results The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1%–25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3%–22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41–1.70, severe depression 1.33, 95% CI 1.18–1.48). The risk of any pDDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: pDDI 1.32, 95% CI: 1.27–1.38, PIM 1.18, 95% CI: 1.14–1.22) and severity of disease (Odds Ratio per point on CGI-Scale: pDDI 1.29, 95% CI: 1.11–1.46, PIM 1.27, 95% CI: 1.11–1.44), respectively. Conclusion This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and pDDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.

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“…a main diagnosis of F32 � or F33 � , ICD-10. Previous publications from this research project can be found in the reference list [10,12,14,[23][24][25][26].…”

Section: Study Samplementioning

confidence: 99%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

et al. 2021

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“…In accordance with the ethics approval, our retrospective study did not require individual patient consent. Previous publications from this research project that have used the same or similar datasets can be found in the reference list 24,26,29,36,38–40 …”

Section: Methodsmentioning

confidence: 99%

“…The pharmacokinetics and ‐dynamics change with increasing age of patients 35 . For this reason, many drugs are considered unsuitable for the elderly 22,36 . Medication is considered to be potentially inappropriate in the elderly if the drug‐related risks outweigh the benefits of better alternatives 37 …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry

Wolff

Hefner

Normann

et al. 2021

Pharmacoepidemiology and Drug

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Purpose The aim of this study was to analyze the epidemiology of polypharmacy in hospital psychiatry. Another aim was to investigate predictors of the number of drugs taken and the associated risks of drug–drug interactions and potentially inappropriate medications in the elderly. Methods Daily prescription data were obtained from a pharmacovigilance project sponsored by the Innovations Funds of the German Federal Joint Committee. Results The study included 47 071 inpatient hospital cases from eight different study centers. The mean number of different drugs during the entire stay was 6.1 (psychotropic drugs = 2.7; others = 3.4). The mean number of drugs per day was 3.8 (psychotropic drugs = 1.6; others = 2.2). One third of cases received at least five different drugs per day on average during their hospital stay (polypharmacy). Fifty‐one percent of patients received more than one psychotropic drug simultaneously. Hospital cases with polypharmacy were 18 years older (p < 0.001), more likely to be female (52% vs. 40%, p < 0.001) and had more comorbidities (5 vs. 2, p < 0.001) than hospital cases without polypharmacy. The risks of drug–drug interactions (OR = 3.7; 95% CI = 3.5–3.9) and potentially inappropriate medication use in the elderly (OR = 2.2; CI = 1.9–2.5) substantially increased in patients that received polypharmacy. Conclusion Polypharmacy is frequent in clinical care. The number of used drugs is a proven risk factor of adverse drug reactions due to drug–drug interactions and potentially inappropriate medication use in the elderly. The potential interactions and the specific pharmacokinetics and ‐dynamics of older patients should always be considered when multiple drugs are used.

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“…The present study analysed a sub-sample of patients with depressive disorders. Previous publications from this research project can be found in the reference list [10,12,14,21,24,25].…”

Section: Methodsmentioning

confidence: 99%

“…Pharmacokinetics and - dynamics change in elderly patients due to the progressive decline in the functional reserve of multiple organs and systems with an influence on drug disposition when aging [18]. Therefore, many drugs are considered inappropriate for the elderly [19–21]. Medication is considered as PIM if risks outweigh benefits of better alternatives [22].…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Wolff

Reißner

Hefner

et al. 2021

Preprint

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Introduction: The aim of this study was to analyse prescription patterns and the determinants of drug-drug interactions (DDI) and potentially inappropriate medication (PIM) in pharmacotherapy of depressive disorders. Methods: Our study was part of a larger pharmacovigilance project funded by the German Innovation Funds. It included all inpatients with a main diagnosis in the group of depressive episodes (F32, ICD-10) or recurrent depressive disorders (F33) discharged from eight psychiatric hospitals in Germany between 1 October 2017 and 30 September 2018 or between 1 January and 31 December 2019. Results: The study included 14,418 inpatient cases. The mean number of drugs per day was 3.7 (psychotropic drugs = 1.7; others = 2.0). Thirty-one percent of cases received at least five drugs simultaneously (polypharmacy). Almost one half of all cases received a combination of multiple antidepressant drugs (24.8%, 95% CI 24.1% - 25.5%) or a treatment with antidepressant drugs augmented by antipsychotic drugs (21.9%, 95% CI 21.3% - 22.6%). The most frequently used antidepressants were selective serotonin reuptake inhibitors, followed by serotonin and norepinephrine reuptake inhibitors and tetracyclic antidepressants. In multivariate analyses, cases with recurrent depressive disorders and cases with severe depression were more likely to receive a combination of multiple antidepressant drugs (Odds ratio recurrent depressive disorder: 1.56, 95% CI 1.41 - 1.70, severe depression 1.33, 95% CI 1.18 - 1.48). The risk of any DDI and PIM in elderly patients increased substantially with each additional drug (Odds Ratio: DDI 1.32, 95% CI: 1.27 - 1.38, PIM 1.18, 95% CI: 1.14 - 1.22) and severity of disease (Odds Ratio per point on CGI-Scale: DDI 1.29, 95% CI: 1.11 - 1.46, PIM 1.27, 95% CI: 1.11 - 1.44), respectively. Conclusion: This study identified potential sources and determinants of safety risks in pharmacotherapy of depressive disorders and provided additional data which were previously unavailable. Most inpatients with depressive disorders receive multiple psychotropic and non-psychotropic drugs and DDI and PIM are relatively frequent. Patients with a high number of different drugs must be intensively monitored in the management of their individual drug-related risk-benefit profiles.

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Potentially inappropriate medication in older psychiatric patients

Cited by 21 publications

References 57 publications

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry

Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders

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