Risk of drug interactions and prescription appropriateness in elderly patients

Petrini, Elisa; Caviglia, Gian Paolo; Pellicano, Rinaldo; Saracco, Giorgio Maria; Morino, Mario; Ribaldone, Davide Giuseppe

doi:10.1007/s11845-019-02148-8

Cited by 21 publications

(17 citation statements)

References 18 publications

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“…Possible explanations for the increased prescription of PPIs could be the frequent use of antiplatelet drugs and self-medication with propionic acid derivatives. Our results regarding the high prevalence of PPIs, especially in the elderly, were in line with findings from other studies [19,20,[27][28][29], suggesting that there was considerable room for improvement regarding the chronic use of PPIs; rational deprescribing of this pharmacological group in selected patients might be a good first step to reduce the risk of adverse events and hospitalizations [30]. There were warnings about their increasing consumption worldwide in both primary and hospital care settings [31,32]: their prolonged use was related to the risk of many adverse events [33,34], so they should be used for specific indications at the minimum effective dose and during the shortest possible period [9,35].…”

Section: Discussionsupporting

confidence: 93%

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

Hernández-Rodríguez

Sempere-Verdú

Vicens

et al. 2021

IJERPH

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We aimed to identify and compare medication profiles in populations with polypharmacy between 2005 and 2015. We conducted a cross-sectional study using information from the Computerized Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP, Spain). We estimated the prevalence of therapeutic subgroups in all individuals 15 years of age and older with polypharmacy (≥5 drugs during ≥6 months) using the Anatomical Therapeutic Chemical classification system level 4, by sex and age group, for both calendar years. The most prescribed drugs were proton-pump inhibitors (PPIs), statins, antiplatelet agents, benzodiazepine derivatives, and angiotensin-converting enzyme inhibitors. The greatest increases between 2005 and 2015 were observed in PPIs, statins, other antidepressants, and β-blockers, while the prevalence of antiepileptics was almost tripled. We observed increases in psychotropic drugs in women and cardiovascular medications in men. By patient´s age groups, there were notable increases in antipsychotics, antidepressants, and antiepileptics (15–44 years); antidepressants, PPIs, and selective β-blockers (45–64 years); selective β-blockers, biguanides, PPIs, and statins (65–79 years); and in statins, selective β-blockers, and PPIs (80 years and older). Our results revealed important increases in the use of specific therapeutic subgroups, like PPIs, statins, and psychotropic drugs, highlighting opportunities to design and implement strategies to analyze such prescriptions’ appropriateness.

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Section: Discussionsupporting

confidence: 93%

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

Hernández-Rodríguez

Sempere-Verdú

Vicens

et al. 2021

IJERPH

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“…In the present study, we found adverse events in 45% of hospitalized patients (INTERCheck ® analysis reported a high class D score for > 80% of these patients). Our findings are consistent with a previous study in patients aged > 75 years that found hospital admission due to adverse drug reactions was as high as one in every three [18]. The cut-off for the number of drugs for the risk of incurring a serious or very serious interaction was found to be five [18]; the mean number of drugs was above eight in our patients.…”

Section: Strengths and Weakness Of The Studysupporting

confidence: 92%

“…Our findings are consistent with a previous study in patients aged > 75 years that found hospital admission due to adverse drug reactions was as high as one in every three [18]. The cut-off for the number of drugs for the risk of incurring a serious or very serious interaction was found to be five [18]; the mean number of drugs was above eight in our patients. It is noteworthy that class D must be considered a contraindicated association between drugs, that should be discontinued or avoided.…”

Section: Strengths and Weakness Of The Studysupporting

confidence: 92%

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Martocchia

Spuntarelli

Aiello

et al. 2020

Drugs - Real World Outcomes

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Background Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug-drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck ® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug-drug interactions. Objectives This observational study used the INTERCheck ® software to evaluate the incidence of adverse events and of drug-drug interactions in outpatients and inpatients receiving multiple medications. Methods Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck ® software, and the prevalence of risk indicators and adverse events was compared between the two groups. Results Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck ® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drugrelated anticholinergic burden and cognitive impairment (r = − 0.30 p = 0.01). Based on the INTERCheck ® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug-drug interactions were associated with adverse events that caused hospitalization (χ 2 = 7.428, p = 0.01). Conclusions INTERCheck ® analysis indicated that inpatients had a high risk of drug-drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck ® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline.

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“…Regardless of SARS-CoV-2 infection, aging and co-morbidities are well recognised independent drivers of the development of drug–drug interactions (DDIs) [ 4 – 6 ]. Aging is associated with physiological changes that significantly affect the pharmacokinetics and pharmacodynamics of various drugs, thus increasing the risk of inappropriate dosing and the development of drug-related toxicity [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Drug–Drug Interactions and Prescription Appropriateness in Patients with COVID-19: A Retrospective Analysis from a Reference Hospital in Northern Italy

et al. 2020

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Background Patients hospitalised with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2; coronavirus 2019 disease (COVID-19)] infection are frequently older with co-morbidities and receiving polypharmacy, all of which are known risk factors for drug–drug interactions (DDIs). The pharmacological burden may be further aggravated by the addition of treatments for COVID-19. Objective The aim of this study was to assess the risk of potential DDIs upon admission and during hospitalisation in patients with COVID-19 treated at our hospital. Methods We retrospectively analysed 502 patients with COVID-19 (mean age 61 ± 16 years, range 15–99) treated at our hospital with a proven diagnosis of SARS-CoV-2 infection hospitalised between 21 February and 30 April 2020 and treated with at least two drugs. Results Overall, 68% of our patients with COVID-19 were exposed to at least one potential DDI, and 55% were exposed to at least one potentially severe DDI. The proportion of patients experiencing potentially severe DDIs increased from 22% upon admission to 80% during hospitalisation. Furosemide, amiodarone and quetiapine were the main drivers of potentially severe DDIs upon admission, and hydroxychloroquine and particularly lopinavir/ritonavir were the main drivers during hospitalisation. The majority of potentially severe DDIs carried an increased risk of cardiotoxicity. No potentially severe DDIs were identified in relation to tocilizumab and remdesivir. Conclusions Among hospitalised patients with COVID-19, concomitant treatment with lopinavir/ritonavir and hydroxychloroquine led to a dramatic increase in the number of potentially severe DDIs. Given the high risk of cardiotoxicity and the scant and conflicting data concerning their efficacy in treating SARS-CoV-2 infection, the use of lopinavir/ritonavir and hydroxychloroquine in patients with COVID-19 with polypharmacy needs to be carefully considered.

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Risk of drug interactions and prescription appropriateness in elderly patients

Cited by 21 publications

References 18 publications

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Drug–Drug Interactions and Prescription Appropriateness in Patients with COVID-19: A Retrospective Analysis from a Reference Hospital in Northern Italy

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