Prescription of proton pump inhibitors in older adults with complex polytherapy

Abstract

ObjectivesPrescription of proton pump inhibitors (PPIs) may be a source of potentially clinically relevant drug–drug interactions (DDIs) and related complications for elderly patients with complex polytherapy at discharge from hospital. The aim of the study was to identify, through the analysis of hospital discharge records, the co-administrations (PPIs + one or more drugs potentially generating DDIs) hypothetically leading to severe consequences according to the literature and online databases. Subsequently, alternatives to PPIs were evaluated for the treatment of gastric acidity and ulcers.MethodsThe medical records of 1288 patients, discharged from a geriatric ward at the Città della Salute e della Scienza Hospital in Turin from January 2012 to December 2013, were collected in an Excel database for analysis of DDIs using the literature and online sources such as Micromedex.Results Six hundred and sixty-three of the 1288 clinical folders had a PPI prescription. A list of 18 drugs considered potentially hazardous and able to trigger a DDI when co-administrated with PPIs was drafted; the frequencies of the co-prescriptions of each PPI with one of the listed drugs were esomeprazole 65.38%, lansoprazole 52.87%, omeprazole 48.19% and pantoprazole 37.11%. An analysis of these co-prescriptions, according to Micromedex classification, gave a percentage of major interactions of 11.01% over 663 clinical folders including a PPI.ConclusionsThis study provides a collection of potentially hazardous drug associations and helpful suggestions to improve the quality of prescriptions for elderly patients and strengthens the case for synergic work between doctors and pharmacists in the wards.

Prescription Habits Related to Chronic Pathologies of Elderly People in Primary Care in the Western Part of Romania: Current Practices, International Recommendations, and Future Perspectives Regarding the Overuse and Misuse of Medicines

“…PPI use was recently associated with the onset of dementia and depression in the elderly population, although the exact mechanism by which this occurs is not clear (it might be due to vitamin B 12 malabsorption). Thus, it is necessary to evaluate the risks and benefits when prescribing PPIs for the elderly for long periods of time and to consider potential drug–drug interactions in patients with polypharmacy, as PPIs are inhibitors of the P450 cytochrome [ 55 , 56 ].…”

Comorbidity in lipoprotein apheresis: Their role in the era of new lipid‐lowering therapies

“…5 In an Italian analysis of general practitioners was reported an average CCI of 1.1 (with an expected mortality rate < 10%), 11 lower than our population where the growing burden of comorbidities significantly increases the prescribed drugs potentially raising the risk of drug interactions and therapeutic adherence. [12][13][14][15][16] It is plausible that the lower observed mortality rate in our population, compared to that predicted by the CCI, is also a consequence of the high compliance obtained by sharing with the patients the nature and severity of their pathology.…”

Evaluation of Potential Drug Interactions with Proton Pump Inhibitors: A Retrospective Study

“…14 In a study conducted in Italy, the most commonly prescribed PPIs drug was found to be omeprazole. 15 These differences may be due to physicians' prescribing habits and changes in the brand's marketing strategy. Some physicians' believe that the older drug is safer and they continue to prescribe omeprazole to their patients.…”

“…18 In a study conducted with 1,288 patients discharged from the hospital in Italy, the highest interaction rate was found between omeprazole-clopidogrel. 15 Longterm use of PPIs may increase the risk of interactions in patients with chronic conditions. 19 There were 114 prescriptions in our study, and the total number of drugs in these prescriptions was found to be 377.…”