Drug Interactions In Elderly Patients Research Articles

Analyzing the Iatrogenic Triad: Discovering Strategies for Preventing Harm in the Elderly.

The iatrogenic triad is a significant global health problem in the elderly population. This study aimed to evaluate the iatrogenic triad in the elderly and identify potential preventive measures to mitigate its occurrence. A preliminary observational study was conducted on 150 ambulatory elderly patients to assess potentially inappropriate medications (PIMs), polypharmacy, and drug interactions. The AGS Beers Criteria 2019, Polypharmacy, Medication Complexity Regimen Index (MRCI), and Micromedex (a drug information software) were used to assess the harmful triad. Before and after data collection, we observed, identified, and unfolded potential strategies to avoid the harmful triad in the elderly population. MRCI is 30.49 ± 13.77, suggesting a moderate level of complexity in the drug regimens of elderly patients. Among the PIMs identified by the AGS Beer criteria for 2019, glimepiride (45) and diclofenac (23) were found to be the most frequently prescribed. Moderate-level drug-drug interactions were identified between aspirin and metoprolol (20), metoprolol and metformin (13), and aspirin and enalapril (11). All drug-ethanol and drug-food interactions were rapid and often unknown to patients. Furthermore, the study found that MRCI and polypharmacy were significantly associated with the number of PIMs and drug interactions (p < 0.01). Based on data collection, this study identified three possible ways to prevent the iatrogenic triad in elderly patients: interaction, collaboration, and continuing education. In conclusion, this study sheds light on medication regimen complexity, PIMs, and drug interactions in elderly patients. The study also highlights three possible ways to prevent the iatrogenic triad: interaction, collaboration, and continuing education. By implementing these strategies, healthcare providers can help prevent harm and improve the quality of care for elderly patients.

Polypharmacy in Older Adults with Alzheimer's Disease.

The number of patients with Alzheimer’s disease is increasing annually. Most of these patients are older adults with comorbid physical illnesses, which means that they are often treated with a combination of medications for the disease they have and those for Alzheimer’s disease. Thus, older adults with Alzheimer’s disease are potentially at risk for polypharmacy. In addition, the drug interactions between Alzheimer’s disease medications and those for the treatment of physical illnesses may reduce their efficacy and increase side effects. This article reviews polypharmacy and drug interactions in elderly patients with Alzheimer’s disease, with a focus on psychotropic drugs.

Drug–Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study

Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.

Prevalence of drug interactions in elderly patients with multimorbidity in primary care.

Background Drug interactions (DIs) are a significant cause of medication-related problems. The aging population, high chronic diseases prevalence and polypharmacy are closely associated factors. Aim of the review To study the prevalence, types and associated factors of DIs in multimorbidity patients of over 65years of age in primary care. Methods Relevant studies on DI prevalence in this population were reviewed in PubMed, Cochrane Library and EMBASE (January 2000-December 2015). Independent variables (duration, target population, age, sex, mean of drugs and diseases, geographical localization, DI databases used and study designs) and dependent variables (prevalence, number of DIs per 100 patients and per patient, number of clinically-relevant DIs per 100 patients, most common DI and associated factors) were classified for each article. Results The search generated 749 articles and 46 duplicates were discarded. After reviewing, 10 articles were included. Seven studies were observational and 3 were quasi-experimental. Seven out of 10 used interaction databases. Only 2 studies described both actual and potential DIs. The prevalence of multimorbidity patients with DI ranged from 25.1 to 100% and the number of DIs per 100 patients was from 30 to 388.3. All the lower values correspond to the study conducted at the nursing home. This could be due to special care offered in these centres, where the medication is more controlled. The most frequent DIs were reported in five articles. However, these results could not be correlated since they were ranked using different methodologies. ACEIs, diuretics and NSAID were the most common therapeutic groups. Finally, 5 studies identified factors associated with the presence of potential DIs. The number of drugs and age were the most significant factors. Conclusions There is little evidence of prevalence of actual and potential DIs in elderly patients with multimorbidity in outpatient settings, showing widely heterogeneous results.

Polypharmacy and drug interactions in elderly patients

Although the definition of polypharmacy is not yet clear today, it is generally regarded as drug use more than the patient needs. Advanced age is the most important risk factor for polypharmacy. In addition, other risk factors are loss of current cognitive functions, low socioeconomic level and nursing care. It is seen in about 40% of people over 75 years of age worldwide, varying between countries of extreme poverty. Incorrect drug use, drug side effects and drug-drug interaction lead to unwanted hospitalizations. In particular, cardiovascular drugs pose risks in terms of drug side effects in advanced ages. Altering the pharmacokinetics and pharmacodynamics of the drug along with advanced age lead to more frequent side effects or no effect of the drugs. The most important point to prevent polypharmacy is to inform the patient or the patient's caregiver fully and to target treatment with a minimum number of drugs and doses.

The efficacy and safety of direct acting antiviral treatment and clinical significance of drug–drug interactions in elderly patients with chronic hepatitis C virus infection

Direct antiviral therapies for chronic hepatitis C virus (HCV) infection have expanded treatment options for neglected patient populations, including elderly patients who are ineligible/intolerant to receive interferon (IFN)-based therapy. To investigate the efficacy, tolerability and potential for drug-drug interactions (DDIs) of IFN-free treatment in patients aged ≥65 years in a large real-world cohort. A total of 541 patients were treated with different combinations of direct antiviral agents (DAAs: ledipasvir/sofosbuvir ±ribavirin; daclatasvir/sofosbuvir ±ribavirin; paritaprevir/ombitasvir ±dasabuvir ±ribavirin or simeprevir/sofosbuvir ±ribavirin in genotype 1/4, and daclatasvir/sofosbuvir ±ribavirin or sofosbuvir/ribavirin in genotype 2/3). Efficacy, safety and potential DDIs were analysed and compared between patients aged <65 years (n = 404) and patients aged ≥65 years (n = 137) of whom 41 patients were ≥75 years. Sustained virological response rates were 98% and 91% in patients aged ≥65 years and <65 years, respectively. Elderly patients took significantly more concomitant medications (79% vs. 51%; P < 0.0001). The number of concomitant drugs per patient was highest in patients ≥65 years with cirrhosis (median, three per patient; range, 0-10). Based on the hep-druginteractions database, the proportion of predicted clinically significant DDIs was significantly higher in elderly patients (54% vs. 28%; P < 0.0001). The number of patients who experienced treatment-associated adverse events was similar between the two age groups (63% vs. 65%; P = n.s.). Elderly patients are at increased risk for significant DDIs when treated with DAAs for chronic HCV infection. However, with careful pre-treatment assessment of concomitant medications, on-treatment monitoring or dose-modifications, significant DDIs and associated adverse events can be avoided.

Actual drug–drug interactions in elderly patients discharged from internal medicine clinic: a prospective observational study

The aim of the study was to evaluate the incidence and type of actual drug-drug interactions (DDIs) that result in adverse drug reactions (ADRs) or diminished therapeutic effect in elderly patients within 30 days of discharge from an internal medicine clinic. A prospective observational study was conducted at the Internal Medicine Clinic of University Hospital Dubrava, Zagreb, Croatia, between October and December 2011. Patients aged ≥ 65 years discharged from the Internal Medicine Clinic during the study period with a prescription for two or more medications were eligible for inclusion in the study. A total of 222 patients were ultimately enrolled in the study. For each patient, potential DDIs were identified using Lexi-Interact software. The follow-up visit was scheduled approximately 30 days after discharge. Causality between DDIs and ADRs or diminished therapeutic effect of drugs was assessed by two independent clinicians. Potential DDIs were identified in 190 (85.6 %) patients. Actual DDIs were detected in 21 (9.5 %) patients. In 19 patients, DDIs resulted in an ADR. Diminished therapeutic effect resulting from DDIs was detected in two patients. Angiotensin-converting enzyme inhibitors were the drug class most frequently associated with DDI-related ADRs. A significant incidence of actual DDIs suggests that DDIs play an important role in patient safety. Drug therapy should be initiated if absolutely necessary, and the number of drugs used to treat elderly patients should be minimized to reduce the incidence of DDI-related adverse patient outcomes.

Complex questions command complex analyses: comparative effectiveness of drug treatment strategies in atrial fibrillation

Among the randomized clinical trials (RCTs) comparing rhythm- with ratecontrol trials conducted in the past 10 years [3–7], the AFFIRM trial is regarded as the most important, owing to its large sample size (4060 participants) and long follow-up (up to 6 years) [7]. Overall, the AFFIRM study showed that the strategy of restoring and maintaining sinus rhythm had no clear advantage in reducing overall mortality over the strategy of controlling the ventricular rate and allowing the AF to persist [7]. This conclusion held after combining the results of AFFIRM [7], and four other smaller trials [3–6], in a single meta-ana lysis estimate (OR: 0.87; 95% CI: 0.74–1.02 vs 1.12; 95% CI: 0.64–1.94 in the pooled ana lysis that included/excluded the AFFIRM trial) [8]. However, many clinicians feel uncomfortable with the rate-control strategy as the main therapeutic approach for AF. For some, the trial results do not mean that the rhythm control is not beneficial, but merely highlight the limitations of the current treatments to achieve and maintain sinus rhythm [9], while others believe the trial results are not generalizable to the full population of AF patients [8]. Such a conundrum demands more evidence through comparative effectiveness studies. To our knowledge, our group has published the first observational comparative effectiveness study of rhythm- versus rate-control drug strategies, published in July 2012 [10]. In this study, we used population-based administrative databases from Quebec (Canada) from 1999 to 2007 to select patients aged ≥66 years, hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission, but received a prescription within 7 days of discharge. The study included 30,664 hospitalized AF patients who were followed-up for up to 8 years and, similar to the trials [7,8], found no difference in mortality between the rhythm- and rate-control drug treatment strategies in the first 3 - years post-treatment initiation. However, our long-term results differed from those of the clinical trials [7,8]; while the AFFIRM trial found no mortality difference at 5 years between the rhythm- and rate-control strategies [7], we found a significant 12% mortality reduction in the rhythm-control group found after 5 years of follow-up and a significant 23% reduc tion after 8 years. In the face of contradictory results between observational studies and RCTs trials, the observational design is oftentimes dismissed as being flawed due to poor control of confounding. We argue here, as others have done before us [11,12], that RCTs and observational studies are complementary designs and that much can be learned by examining results from different study designs and analyses [13,14]. Bias, due to unobserved confounding, is the Achilles’ heel of observational studies of drug effects [15–20], with lack of randomization being a particular concern in studies

The incidence of potential drug–drug interactions in elderly patients with arterial hypertension

To assess the incidence and type of potential, clinically significant drug-drug interactions in elderly outpatients with arterial hypertension. Three community pharmacies in Croatia. Eligible patients were aged 65 or older, treated for arterial hypertension and received 2 or more drugs. Potential interactions were identified by Lexi-Interact software. The software categorized each potential interaction according to clinical significance in five groups: (A) No known interaction; (B) Specified agents may interact, but there is little to no evidence of clinical concern; (C) Specified agents may interact in a clinically significant manner. Monitoring therapy is suggested; (D) The two medications may interact in a clinically significant manner. Modification of therapy is suggested; (X) Contraindicated combination. Interactions of level C, D and X were considered clinically significant. The incidence and type of potential drug-drug interactions. There were 265 patients included in the study. Potential, clinically significant drug interactions were identified in 240 (90.6%) patients, out of which 97.9% had interactions with clinical significance C, 20.4% D, and 0.8% X. The median number of drug interactions per patient was 4. We identified 215 drug combinations with the potential to cause clinically significant interaction, out of which 83.3% had clinical significance C, 16.3% clinical significance D, and 0.4% clinical significance X. Drug-drug interactions are common in elderly hypertensive patients. Computer-based screening could help pharmacists and physicians to recognize potential, clinically significant interactions.

Comments on “The relation between Helicobacter pylori infection and cardiac syndrome X: A preliminary study", Assadi M, et al.

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Preventing Drug Interactions with Antidepressants in the Elderly

With the progressive aging of the population, late-life depression will increase in importance as a public health problem and prescriptions of antidepressants will presumably grow, thus enhancing the likelihood of drug interactions. After considering the general mechanisms and the various factors predisposing elderly subjects to drug interactions, the interaction potential for each class of antidepressant drugs will be examined, in order to help the prescribing physician in the selection of the most appropriate agent for an elderly patient receiving concomitant medications. Some general recommendations to prevent or minimize the occurrence of adverse drug interactions in elderly patients with depression will be given. Potential intervention strategies, targeted to adequately supply health professionals with information on the risks of clinically relevant drug interactions, are discussed in depth.

Drug interactions in elderly patients

Drug interactions in elderly patients

高齢患者の多剤併用療法における薬物相互作用の危険性

As Japan becomes an increasingly aged society, we believe that a survey and analysis of prescription medication use by elderly patients will provide valuable information for selecting appropriate drug therapies. We surveyed changes in the number of outpatients examined and the number of concomitant drugs prescribed to elderly patients in our hospital, and the risk of adverse drug interactions in elderly patients undergoing polypharmacy.The ratio of elderly patients was relatively high in every department at our hospital except for pediatric patients. The total number of departments in which patients were examined tended to increase with age. The number of drugs taken in the elderly group was significantly larger than for the other groups, and the incidence of concomitant drug interaction increased with the number of drugs prescribed. As a result, a higher risk of adverse reactions to polypharmacy was observed in elderly patients.We therefore recommend devising a way to prescribe fewer drugs regarding both drug-interaction and the risk of adverse reaction. Elderly patients are examined in several departments and medical facilities, and so it is important to create a network system to centrally manage information on which drugs are actually prescribed, in order to avoid or decrease this risk.

Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department

Study Objectives: We sought to document the degree of polypharmacy, the frequency of adverse drug-related events (ADREs) leading to emergency department presentation that were recognized by emergency physicians, and the frequency of potential adverse drug interactions (PADIs) in medication regimens of elderly patients in the ED. Methods: We conducted a retrospective chart review on 300 randomly selected ED visits made by patients 65 years of age and older between January 1 and December 31, 1998. ADREs were defined according to a standardized algorithm. PADIs were identified by using the drug interaction database PharmVigilance. Results: After excluding 17 patient visits with inadequate documentation, 283 were left for review. Of these, 257 (90.8%) patients were taking 1 or more medications (prescribed or over the counter). The number of medications consumed ranged from 0 to 17 and averaged 4.2 (SD±3.1) drugs per patient. ADREs accounted for 10.6% of all ED visits in our patient group. The most frequently implicated classes of medications were nonsteroidal anti-inflammatory drugs, antibiotics, anticoagulants, diuretics, hypoglycemics, β-blockers, calcium-channel blockers, and chemotherapeutic agents. Thirty-one percent of all patients in our group had at least 1 PADI in their medication list. Among patients who presented because of an ADRE, 50% had at least 1 PADI in their medication list that was unrelated to the ADRE with which they presented. Conclusion: ADREs are an important cause of ED presentation in the elderly. PADIs are found in a significant proportion of medication lists. Emergency physicians must be vigilant in monitoring elderly patients for medication-related problems. [Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. December 2001;38:666-671.]