A Scoping Review of Medications Studied in Pediatric Polypharmacy Research

Horace, Alexis; Golchin, Negar; Pestana-Knight, Elia M.; Dawson, Neal V.; Ma, Xuan; Feinstein, James A.; Johnson, Hannah; Kleinman, Lawrence C.; Bakaki, Paul M.

doi:10.1007/s40272-019-00372-4

Cited by 13 publications

(16 citation statements)

References 55 publications

(68 reference statements)

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“…This leaves clinicians with the task of determining up the benefit vs harms ratio. With what appears to be an increasing trend in pediatric polypharmacy, the creation of thorough guidelines and pediatric‐focused initiatives would be useful 41 …”

Section: Discussionmentioning

confidence: 99%

“…With what appears to be an increasing trend in pediatric polypharmacy, the creation of thorough guidelines and pediatric-focused initiatives would be useful. 41 The lack of information regarding polypharmacy in young people means that we do not know if typical interventions would be effective or if novel methods need to be developed and trialed. One possibility is raising awareness of medicines at high risk of causing adverse effects;…”

Section: Polypharmacy By Agementioning

confidence: 99%

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A whole of population retrospective observational study on the rates of polypharmacy in New Zealand 2014 to 2018 Polypharmacy in New Zealand: What is the current status?

Nind

Smith

Devananda³

et al. 2021

Health Science Reports

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Background and Aims Polypharmacy (≥5 medicines) and hyperpolypharmacy (≥10 medicines) can significantly impact people's health. The literature surrounding polypharmacy focuses on the elderly, particularly rest home populations, with few studies looking into younger age bands. Moreover, there have been no recent studies looking into the rates of polypharmacy in New Zealand. This study aimed to determine whether polypharmacy rates have increased over time in the New Zealand population. Specifically investigating polypharmacy rates across age and ethnicity, and identifying which medicines are most commonly prescribed in people with polypharmacy. Methods A nationwide retrospective observational study was carried out between 2014 and 2018 on 4 697 274 New Zealanders (96% of the population) by linking dispensing data from the Pharmaceutical Collection to patient enrolment data using a National Health Identifier (NHI) to identify the rate of long‐term medicine prescribing in New Zealand. Results Our study found the rate of polypharmacy to be 9.93% and hyperpolypharmacy to be 1.92% nationwide in 2018, a percentage increase of 4.1% and 7.11% from 2014, respectively. During the same period, we observed the greatest percentage increase (30.37%) in the rate of polypharmacy in the 20 to 29 age band while the rates decreased in older populations. Variation was also noted between ethnicities. Medicines contributing to polypharmacy differed by age group. Conclusion Current methods for minimizing polypharmacy and optimizing medicines use are narrowly focused on the elderly. Despite an increase in education and awareness raising campaigns, rates continue to rise in New Zealand's population.

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Section: Discussionmentioning

confidence: 99%

Section: Polypharmacy By Agementioning

confidence: 99%

A whole of population retrospective observational study on the rates of polypharmacy in New Zealand 2014 to 2018 Polypharmacy in New Zealand: What is the current status?

Nind

Smith

Devananda³

et al. 2021

Health Science Reports

View full text Add to dashboard Cite

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“…Overall the prevalence of psychotropic polypharmacy ranges from 14% to 73% amongst the paediatric population 6 . According to a recent systematic review, anticonvulsant (60.4%), antipsychotic (30.2%), and antidepressant (26.1%) drugs were identified as the most commonly studied pharmacological classes in paediatric polypharmacy studies 7 . Medhekar et al determined that the number of hospitalisations, number of prescribers, and number of comorbidities were risk factors for psychotropic polypharmacy 5 .…”

Section: Introductionmentioning

confidence: 99%

Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

et al. 2021

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Aims Polypharmacy and drug‐drug interactions (DDIs) are important problems that necessitate more attention in paediatric inpatients. This study aimed to determine and evaluate DDIs in paediatric inpatients using psychotropic drugs. Methods It was conducted as a retrospective cross‐sectional study. Inpatients consulted by child and adolescent psychiatrists (CAPs) and had at least one psychotropic drug‐using between January 2016 and September 2017 were retrospectively included. To determine the clinical significance of DDIs by Micromedex® and DDI Predictor online databases. DDIs between psychotropic and other drugs, the type, severity, and duration of potential DDIs were evaluated. Results During the study period, 564 patients’ records were reviewed and 200 patients were considered eligible and included in the study. The median (min‐max) age was 13.70 (1.5‐17.83) years. The mean (SD) number of psychotropics used during hospitalisation was 1.29 (0.55) and the total number of drugs was 7.39 (4.45). A total of 336 potential DDIs were detected (2.19 DDIs/patient) in all patients. The most common potential outcome of psychotropic DDIs was drug‐induced QTc prolongation (67.56%). While 92.85% of the potential DDIs were “contraindicated” or “major,” only 18.46% had a “good” or “excellent” strength of evidence. The risk of psychotropic polypharmacy (OR:0.73, 95% CI 0.59‐0.92; p:0.006) and DDIs (OR:0.69, 95% CI 0.35‐0.76; p:0.033) was significantly higher in patients without primary psychiatric disorders. When the total number of drugs and the total number of potential DDIs were compared amongst all inpatient units, significant differences were found between paediatric hematology‐general paediatrics (mean difference: 2.002; P < .001) and paediatric hematology‐paediatric ICU (mean difference: 1.650; P = .012), respectively. Conclusion Psychotropic drug‐related DDI is a major problem in the paediatric population and the clinical significance of the potential DDIs’ risk should be determined in patient‐centred care and managed by the multidisciplinary team.

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“…In contrast, polypharmacy has been reported as the use of two or more prescribed medications for children recently 11 . Although the increased risks may be extrapolated to children, most reports on the increased risks are limited to polypharmacy involving psychotropic medications or for psychiatric patients [11][12][13][14][15] . There are a few studies on the effects of polypharmacy on ADR prevalence in children with various disease types 16,17 .…”

mentioning

confidence: 99%

Effects of the number of drugs used on the prevalence of adverse drug reactions in children

Sugioka

Tachi

Mizui

et al. 2020

Sci Rep

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In pediatric individuals, polypharmacy would increase the prevalence of adverse drug reactions (ADRs). However, there is no report on the ADR increase adjusted for the influence of concomitant disease types. We conducted a retrospective study in pediatric patients to determine whether polypharmacy is a risk factor for ADR development, after the adjustment. Patients aged 1–14 years on medication who visited Gifu Municipal Hospital (Gifu, Japan) were included. We evaluated patient characteristics, ADR causality, ADR classification and severity, and ADR-causing drugs. We examined the association between ADR prevalence and number of drugs used. We performed multiple logistic regression analyses to investigate risk factors for ADR development. Of 1330 patients, 3.5% sought medical attention for ADRs. ADR causality was most often assessed as “possible,” with gastrointestinal ADRs being the most common. Grade 1 ADRs were the most and antibiotics were the most common suspected ADR-inducing drug. The multiple logistic regression analysis showed that ≥ 2 or ≥ 4 drug use, neoplasms, mental and behavioral disorders, and circulatory system diseases significantly increased ADR prevalence. Polypharmacy increased the prevalence of ADR resulting in hospital visits in children, after adjusting for the influence of disease types. Therefore, proactive polypharmacy control measures are necessary for children.

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A Scoping Review of Medications Studied in Pediatric Polypharmacy Research

Cited by 13 publications

References 55 publications

A whole of population retrospective observational study on the rates of polypharmacy in New Zealand 2014 to 2018 Polypharmacy in New Zealand: What is the current status?

A whole of population retrospective observational study on the rates of polypharmacy in New Zealand 2014 to 2018 Polypharmacy in New Zealand: What is the current status?

Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

Effects of the number of drugs used on the prevalence of adverse drug reactions in children

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