Abstract
Older adults are at increased risk of several cytochrome P450 (CYP) drug interactions that can result in drug toxicity, reduced pharmacological effect, and adverse drug reactions. This study aimed to assess the prevalence of potential CYP interactions referring to the most clinically relevant drugs and exploring the relationship between them and quality of life and physical performance in Spanish octogenarians. Institutionalized and community-dwelling octogenarians (n = 102) treated at three primary care centers, were recruited by a research nurse. Anthropometric measurements, chronic diseases, prescribed drugs, quality of life, physical performance, mobility skills, hand grip strength and cognitive status data were collected. Potential CYP drug-drug interactions (DDIs) were selected referring to the main CYP implicated in their metabolism. The 72.2% of recruited octogenarians presented potentially inappropriate CYP inhibitor-substrate or CYP inductor-substrate combinations. Analyzing the EuroQol Visual Analogue scale (EQ-VAS) results, patients with a potential CYP DDI perceived worse health status than patients without it (p = 0.004). In addition, patients with a potential CYP DDI presented worse exercise capacity, kinesthetic abilities, or mobility than those who didn’t present a potential interaction (p = 0.01, p = 0.047, and p = 0.02, respectively). To investigate and control factors associated with loss of muscle strength and poor quality of life, polypharmacy and DDIs could help institutions in the management of physical frailty.
Highlights
Polypharmacy is a term used to describe the situation in which a patient is taking five or more drugs [1]
It often occurs among elderly people and is associated with an increased risk of drug-drug interactions (DDIs), which impact on patient health, effectiveness of drugs, and increased medical costs [2]
Drug metabolism via the cytochrome P450 (CYP) system has emerged as an important determinant in the incidence of several DDIs that can result in drug toxicities, reduced pharmacological effect, and adverse drug reactions [2,3,4]
Summary
Polypharmacy is a term used to describe the situation in which a patient is taking five or more drugs [1]. It often occurs among elderly people and is associated with an increased risk of drug-drug interactions (DDIs), which impact on patient health, effectiveness of drugs, and increased medical costs [2]. The CYP enzymes are a superfamily of mono-oxigenases that metabolize many different drugs. 75% of drugs are cleared by phase I hepatic metabolism and about 70% of these involve metabolism by CYP enzymes [5]. Serious adverse effects may occur when high plasma levels of a substrate drug result from the co-administration of a drug that inhibits its metabolism
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