The potential for drug interactions

Karas, Stephen

doi:10.1016/s0196-0644(81)80085-6

Cited by 71 publications

(29 citation statements)

References 4 publications

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“…The number of potential interactions increases in a logarithmic fashion as the number of medications increases. 38 Seniors represent the greatest proportion of the population at risk for exposure to a potential clinically significant interaction. …”

Section: Characteristics Of Older Adults Who Meet the Annual Prescripmentioning

confidence: 99%

Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

Daniel¹,

Malone²

2007

JMCP

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Section: Characteristics Of Older Adults Who Meet the Annual Prescripmentioning

confidence: 99%

Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

Daniel¹,

Malone²

2007

JMCP

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“…The theoretical risk of drug-drug interactions has been estimated to be over 50% in patients receiving 5 medications, with the probability reaching 100% when 7 drugs are taken (fig. 2; [59]). This premise has been confirmed by a recent study, which has reported that risk of drug-drug interactions increases significantly in patients receiving more than 8 prescription drugs (p = 0.0004) [60].…”

Section: Drug-drug Interactionsmentioning

confidence: 99%

5-HT<sub>3</sub>-Receptor Antagonists in the Management of Nausea and Vomiting in Cancer and Cancer Treatment

Aapro¹

2005

Oncology

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The 5-HT₃-receptor antagonists, considered as ‘gold standard’ therapy for cancer patients, are generally perceived to have similar efficacy and safety profiles, andmost antiemetic guidelines do not distinguish between agents. However, important pharmacological differences exist between agents, which may translate into potential benefits for some patients. In particular, 5-HT₃-receptor antagonists vary in the nature of their receptor antagonism and plasma half-lives, possibly leading to differences in duration of action. Agents with a longer duration of action provide antiemetic protection throughout the acute emetic period (24 h) with a single daily dose, whereas shorter-acting agents, e.g. ondansetron, may require multiple dosing for full efficacy. Differences also exist between agents in their hepatic metabolism and cardiovascular safety, which may present particular problems for elderly patients who often receive additional medications for comorbid conditions, increasing the risk of drug-drug interaction. Recent antiemetic guidelines from the National Comprehensive Cancer Network recommend preferential use of palonosetron for moderately emetogenic chemotherapy; however, this agent is newly approved and key clinical questions remain unanswered by clinical trial data. Selection of an appropriate 5-HT₃-receptor antagonist should be based on proven efficacy and safety, as well as on the individual characteristics of the patient.

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“…In addition, we did not study adverse drugdrug interactions or possible underuse of appropriate medications. [41][42][43][44] Appropriateness criteria such as those of Beers have strengths and limitations as quality of care standards for medication use, and these need to be acknowledged more clearly. [45][46][47][48][49][50] Explicit process criteria are not measures of actual clinical outcome, 51 and the standards assume that some patients will not tolerate the drugs.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

Appropriateness of Medication Selection for Older Persons in an Urban Academic Emergency Department

Chin

Wang

Jin

et al. 1999

Academic Emergency Medicine

172

130

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Abstract. Objectives:To determine the frequency of potentially inappropriate medication selection for older persons presenting to the ED, the most common problematic drugs, risk factors for suboptimal medication selection, and whether use of these medications is associated with worse outcomes. Methods: The authors performed a prospective cohort study of 898 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Seventy-nine percent of the patients were African-American and 43% did not graduate from high school. Potentially inappropriate medications and adverse drug-disease interactions were identified using the 1997 Beers explicit criteria for elders. During the three months after the initial visit, revisits to the ED or hospital, death, and changes in health-related quality of life were analyzed as measured by validated questions adapted from the Medical Outcomes Study. Results: Upon presentation, 10.6% of the patients were taking a potentially inappropriate medication, 3.6% were given one in the ED, and 5.6% were prescribed one upon discharge from the ED. The most frequently prescribed potentially inappropriate medications in the ED were diphenhydramine, indomethacin, meperidine, and cyclobenzaprine. Emergency physicians added potentially inappropriate medications most often to patients with discharge diagnoses of musculoskeletal disorder, back pain, gout, and allergy or urticaria. Potentially adverse drug-disease interactions were relatively uncommon at presentation (5.2%), in the ED (0.6%), and on discharge from the ED (1.2%). Potentially inappropriate medications and adverse drug-disease interactions prescribed in the ED were not associated with higher rates of revisit to the ED, hospitalization, or death, but were correlated with worse physical function and pain. However, confidence intervals were wide for analyses of revisits and death. Conclusions: Suboptimal medication selection was fairly common and was associated with worse patient-reported health-related quality of life. Key words: emergency services; aging; drugs; pharmacology; outcomes; quality of care. ACADEMIC EMER-GENCY MEDICINE 1999; 6:1232-1242 A DVERSE drug reactions are common and expensive. For example, a recent meta-analysis estimated that 6.7% of hospitalized patients have serious adverse drug reactions.1 In the outpatient setting, rates of adverse drug reactions have ranged from 1.7% to 50.6%.2 Costs associated with adverse drug events in a typical tertiary care hospital have been approximated to be $1.1-5.6 million per year, 3,4 and drug-related morbidity and mortality have been estimated to cost $76.6 billion annually in the ambulatory setting.5 Therefore, clinicians, administrators, and policymakers have become interested in what system factors contribute to adverse drug reactions and how provider practices around medication prescribing can be improved. 6,7 Several factors place older persons at especially high risk for iatrogenic complications of medication use. The normal aging process is associated with ...

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The potential for drug interactions

Cited by 71 publications

References 4 publications

Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

5-HT<sub>3</sub>-Receptor Antagonists in the Management of Nausea and Vomiting in Cancer and Cancer Treatment

Appropriateness of Medication Selection for Older Persons in an Urban Academic Emergency Department

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