Availability and actual use in the Belgian market of potentially inappropriate medications (PIMs) from the EU(7)-PIM list.

Abstract

Inappropriate prescribing puts older adults (≥65 years) at risk for adverse drug reactions [1]. Recently, a European list of potentially inappropriate medications (PIMs) was developed, the EU(7)-PIM list [2]. Experts from the seven participating countries (EE, NL, FI, ES, FR, SE, DE) screened their medication market for PIMs, using existing lists of explicit criteria [1, 3–5]. The experts developed the EU(7)-PIM list using a two-round Delphi panel. See Annex 1 for more details on the development and content. Our first aim was to check the Belgian market on the availability of potentially inappropriate medications as listed in the EU(7)-PIM list. Second, we studied the actual use of PIM products in a cohort of oldest old (≥80 years). To check the availability, we cross-referenced the official register of medications in Belgium (coded in Anatomical Therapeutic Chemical (ATC)) to the EU(7)-PIM list. Of the 275 active substances in the EU(7)-PIM list, 157 were available in Belgium. Of those, 139 products were only available on prescription. The seven medication classes in the EU(7)PIM list contain a total of 60 active substances in the ATC classification, of which 21 were available in Belgium (three antacid combinations and complexes, five proton-pump inhibitors, two iron supplements, four estrogens, and seven triptanes). The medication classes of antacids containing aluminium compounds, and quinine and derivates, were not available in Belgium as registered medications. To check the actual use of PIM products, we used the Belfrail-MED cohort of 503 Belgian community-dwelling oldest old (≥80 years, range 80–102 years) [6, 7]. See Annex 2 for more background on the Belfrail-Med cohort. For this, all prescribed, chronic medications with systemic action in this population were recorded, coded into ATC, and crossreferenced to the EU(7)-PIM list. In the oldest old, the mean number of medications was 5.4 (range 0–16). Of the possible 157 PIM products in Belgium, 77 were identified in this cohort. All five available medication classes were identified as well. In this cohort, 72.8 % of patients took at least one PIM product. Lorazepam was the most prescribed PIM product (10.7 % of patients) and proton pump inhibitors the most prescribed medication class (17.3 % of patients). See Annex 3 for background on the PIMs identified in Belgium. While scanning the Belgian medication market, we identified a few other potentially inappropriate medications, not considered in the EU(7)-PIM list, because possibly not available in the participating countries. See Annex 4 for possible additions to the EU(7)-PIM list. Also, PIM products available in combination products should be discussed. For instance, loperamide (A07DA03) is listed as a PIM product, but the combination of loperamide in the same dose with simethicone (A07DA53) is not. For the Belgian situation, there are 61 combinations containing a PIM product (see Annex 3). We encourage other European countries, not (yet) participating in the EU(7)-PIM list, to repeat this exercise to gain insights in remaining overlaps or gaps of PIMs available in each national medication market. We urge the authors of the EU(7)-PIM list to (1) explicitly list all active substances in the medication classes and (2) to address the problem of combinations containing PIMs. Also, (3) a procedure must be Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1947-3) contains supplementary material, which is available to authorized users.