Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain

Navalón, Carles Iniesta; Gascón-Cánovas, Juan José; Gama, Zenewton André da Silva; Sánchez-Ruiz, José Francisco; Gutiérrez-Estrada, Erick Angelico; De-la-Cruz-Sánchez, Ernesto; Harrington-Fernández, Owen

doi:10.1590/1413-81232018245.16032017

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…As described previously, the frequency of severe/moderate DDIs was 24.7%. Reported frequencies of DDIs vary between 15 and 70% [ 41 , 42 , 43 , 44 , 45 ]; 55.4% of our participants were exposed to one or more severe/moderate DDIs, which is higher than the values provided from NHs by other authors (25.5% [ 11 ] and 37.8% [ 40 ]). As in other studies, a strong association between an increasing number of drugs and DDIs has been observed [ 46 , 47 ], but it should be taken into account that there are discrepancies in the literature due to the different sensitivity of the tools used to detect these interactions [ 25 , 48 , 49 , 50 , 51 , 52 ].…”

Section: Discussioncontrasting

confidence: 62%

“…This situation is more evident for nursing home (NH) residents, who are provided care and support for daily living activities as well as medical and non-medical assistance. Institutionalised residents tend to use more drugs and in larger doses, and they usually show other characteristics (poor mental health, frailty, or lower physical activity, among others) which exposes them to DDIs [ 9 , 10 , 11 ] and, in general, drug-related problems (DRP). Several studies have indicated that the use of potentially inappropriate medication (PIM) in the elderly is also common in NH settings: 23.7–70% of residents had at least one PIM [ 12 , 13 , 14 , 15 , 16 ], and 25.1–37.8% experienced potential DDIs, being 72% of moderate or major severity [ 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Díez

Cadenas

Susperregui

et al. 2022

IJERPH

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At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain’s most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Díez

Cadenas

Susperregui

et al. 2022

IJERPH

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show abstract

“…Polypharmacy in our cohort was significantly associated with the number of major DDIs. This was the strongest association (although it has still to be considered as weak) and has been confirmed by previous studies [37,55,60]. Evidence regarding associations between DDIs and other patient-related factors (which were missing in our cohort) is inconsistent; some research detected higher DDI prevalences in patients with older age [55], male sex [43,55] respectively multimorbidity [60].…”

Section: Polypharmacy and Associated Factorssupporting

confidence: 80%

Epidemiology and associated factors of polypharmacy in older patients in primary care: a northern Italian cross-sectional study

et al. 2021

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Background A precondition for developing strategies to reduce polypharmacy and its well-known harmful consequences is to study its epidemiology and associated factors. The objective of this study was to analyse the prevalence of polypharmacy (defined as ≥8 prescribed drugs), of potentially inappropriate medications (PIMs) and major drug-drug interactions (DDIs) among community-dwelling general practice patients aged ≥75 years and to identify characteristics being associated with polypharmacy. Methods This cross-sectional study is derived from baseline data (patients’ demographic/biometric characteristics, diagnoses, medication-related data, cognitive/affective status, quality of life) of a northern-Italian cluster-RCT. PIMs and DDIs were assessed using the 2012 Beers criteria and the Lexi-Interact® database. Data were analysed using descriptive methods, Wilcoxon rank-sum tests, Fisher’s exact tests and Spearman correlations. Results Of the eligible patients aged 75+, 13.4% were on therapy with ≥8 drugs. Forty-three general practitioners and 579 patients participated in the study. Forty five point nine percent of patients were treated with ≥1 Beers-listed drugs. The most frequent PIMs were benzodiazepines/hypnotics (19.7% of patients) and NSAIDs (6.6%). Sixty seven point five percent of patients were exposed to ≥1 major DDI, 35.2% to ≥2 major DDIs. Antithrombotic/anticoagulant medications (30.4%) and antidepressants/antipsychotics (23.1%) were the most frequently interacting drugs. Polypharmacy was significantly associated with a higher number of major DDIs (Spearman’s rho 0.33, p < 0.001) and chronic conditions (Spearman’s rho 0.20, p < 0.001), higher 5-GDS scores (thus, lower affective status) (Spearman’s rho 0.12, p = 0.003) and lower EQ-5D-5L scores (thus, lower quality of life) (Spearman’s rho − 0.14, p = 0.001). Patients’ age/sex, 6-CIT scores (cognitive status), BMI or PIM use were not correlated with the number of drugs. Conclusions The prevalence of polypharmacy, PIMs and major DDIs was considerable. Results indicate that physicians should particularly observe their patients with multiple conditions, reduced health and affective status, independently from other patients’ characteristics. Careful attention about indication, benefit and potential risk should be paid especially to patients on therapy with specific drug classes identified as potentially inappropriate or prone to major DDIs in older persons (e.g., benzodiazepines, NSAIDs, protonic pump inhibitors, antithrombotics/anticoagulants, antidepressants/antipsychotics). Trial registration The cluster-RCT on which this cross-sectional analysis is based was registered with Current Controlled Trials Ltd. (ID ISRCTN: 38449870) on 2013-09-11.

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“…25 According to the classification of the DI in terms of their monitorability, it was possible to verify that most DI were classified as monitorable (90.9%), but few were associated with a detectable clinical consequence (27%), very similar to that found by Dumbreck et al 24 These results reveal that the pharmacist could and should easily use clinical parameters to determine the existence of a DI whenever possible, since the identification of a potential DI in the pharmacotherapy does not necessarily reflect a clinical alteration. 2,26 That is, when it comes to a monitorable DI, continuous attention to the parameters of effectiveness and safety of each medication can go a longer way than the identification of all DI and their communication to the health team.…”

Section: Discussionmentioning

confidence: 99%

Drug interactions in the pharmacotherapy of patients included in primary care comprehensive medication management services

Silva¹,

Oliveira²,

Martins³

et al. 2021

Rev Bras Farm Hosp Serv Saude

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Objective: A drug interaction (DI) is the clinical event in which the effect or action of one drug is modified by the presence of another. Because of potential harms and low consistency of available information, it is critical to assess the clinical relevance of DI. This study aimed to identify and evaluate the clinical consequences of DI in the pharmacotherapy of patients followed in a primary care Comprehensive Medication Management (CMM) services. Methods: This observational cross-sectional study was based on the analysis of the CMM records all the patients that used at least two medications and attended to at least three CMM consultations from August 2015 to March 2016 (n=88). Potential DI were identified among the medications used in the initial consultation of CMM using Micromedex® Drug-Reax® software. The DI were classified as “monitorable” (when its clinical consequences could be monitored by effectiveness or safety paremeters) or non-monitorable, and their clinical consequences were evaluated by analysis of CMM records. Results: Among the studied population 95.5% of the patients had at least one potential DI in their pharmacotherapy, totaling 493 potential DI. Of all the potential DIs identified, 90.9% were monitorable, and the majority of these monitorable DI presented no clinical consequences (62.7%). For 63.9% of the DI with clinical impact, the pharmacist adopted direct or indirect measures that would favor the resolution or reduction of the clinical impact of DIs. Conclusion: The CMM service facilitates the management of DIs since its decision-making method calls for monitoring of the effectiveness and safety parameters, individualizing the management of DIs according to the patient’s needs and their clinical consequences.

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Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain

Cited by 6 publications

References 15 publications

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Epidemiology and associated factors of polypharmacy in older patients in primary care: a northern Italian cross-sectional study

Drug interactions in the pharmacotherapy of patients included in primary care comprehensive medication management services

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