Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Ahmed, Bilal; Nanji, Kashmira; Patel, Jignesh

doi:10.1093/ije/dyv096.212

Cited by 25 publications

(42 citation statements)

References 19 publications

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“…Comparatively, it is lesser than the study conducted in the elderly patients 70%. 28 This difference could be due to the difference in the methodological aspects of the study particularly the study population and the direct supervision of healthcare team over the patient in the wards. The geriatric population of 61-70 years age group developed 38.6% of adverse drug reactions due to polypharmacy comparatively lesser than the study conducted where it was 70%.…”

Section: Discussionmentioning

confidence: 99%

“…The geriatric population of 61-70 years age group developed 38.6% of adverse drug reactions due to polypharmacy comparatively lesser than the study conducted where it was 70%. 28 The synergistic effect of two or more drugs can be toxic even more than the drug when administered alone. The risk of peptic ulcers in the elderly patient's increases by 10% with the use of NSAIDs compared to others.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Predisposing Factors Associated with Suspected Adverse Drug Reactions of Hospitalized Patients

Mudigubba¹,

Rajashekarachari²,

Dahiya³

2018

JYP

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Objectives: To study the incidence and to evaluate the risk factors of suspected adverse drug reactions developed in the hospitalized patients of various departments and to assess the causality and severity of adverse drug reactions (ADRs). Methods: It was a retrospective-prospective study conducted in a tertiary care hospital for a period of two years two months, with a specific predefined criterion. A total of 254 subjects with ADRs were identified during the period of study for which 1:1 ratio of subjects with non-ADRs were taken. Subjects of all age groups and of either sex were enrolled. Risk factors included subjects' age group, gender, polypharmacy, comorbidity, intercurrent diseases and concurrent interactive drugs. Statistical analysis used: Multiple logistic regression analysis was performed to find the association of risk factors with adverse drug reactions. Results: The incidence of suspected adverse drug reactions in hospitalized patients was13% (254/1952, 95%CI). Polypharmacy was the most significant predictor of adverse drug reactions (OR=55.952; 95%CI). Elderly population with multidrug therapy had developed the higher rate of ADRs. Cephalosporin's 27.6%, fluoroquinolones 15.5%, penicillamines 12.1%, anti-hypertensive 8.7%, NSAIDs 8.3% were more frequently implicated. Risk factors for suspected ADRs were: age (more than 60 years) (OR=1.033: 95% CI), gender [Male (OR=55.952; 95% CI)], comorbidity (OR=1.008; 95% CI), intercurrent diseases (OR=19.27; 95% CI). Conclusion: Polypharmacy, history of ADR, concurrent interactive drugs and inter current disease were the significant risk factors of adverse drug reactions. The elderly population was the vulnerable age group for ADRs. Multidrug therapy and comorbidity resulted in higher risk of ADRs in an older population. The Higher rate of suspected ADRs were probable and very less severe. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Mudigubba et al.: Evaluation of Predisposing Factors Associated with Suspected Adverse Drug Reactions of Hospitalized PatientsJournal of Young Pharmacists, Vol 10, Issue 2, Apr-Jun, 2018203 were interviewed about the previous medical and medication history, co-morbid conditions, lifestyle and diet which were also updated inpatient case sheet for future reference. Retrospectively case data was collected from the reported documents which were stored in drug information centre and control data from the medical record database of the hospital. The patients who had no ADR were selected as controls. The severity of suspected adverse effects was assessed as mild, moderate and severe by using the specific standard scale called Hart wig and Siegel's scale, and the Naranjo`s algorithm was used to assess the causal relationship between the suspected drug and ADR. For evalu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Predisposing Factors Associated with Suspected Adverse Drug Reactions of Hospitalized Patients

Mudigubba¹,

Rajashekarachari²,

Dahiya³

2018

JYP

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“…This percentage increases with age and is about 83% for those 75 years or older. [15] The increase in life expectancy has increased the susceptibility to various diseases for which medical advice is sought. Another important point for this age group is the use of disproportionately high number of drugs as compared to the younger adults and the associated risk of increased vulnerability to adverse reactions of drugs.…”

Section: Discussionmentioning

confidence: 99%

“…This percentage increases with age and is about 83% for those 75 years or older. [15] Patients, not being completely satisfied with the level of relief from the modern system of medicines, are on the lookout for any other kind of therapy which claims to offer better control or complete cure of such age-related ailments. This may lead to trying out the various modalities of CAM, more in comparison to other age groups.…”

Section: Discussionmentioning

confidence: 99%

Use of complementary and alternative medicines in Indian elderly patients

Sharma¹,

Dubey²,

Malhotra³

et al. 2017

Natl J Physiol Pharm Pharmacol

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Background: Use of complementary and alternative medicine (CAM) is more common in elderly patients due to the prevalence of various age-related chronic medical conditions. The pharmacokinetics and pharmacodynamics change with age and are different in the elderly as compared to a young adult. Non-disclosure of CAM usage voluntarily by the patients, along with the practice of poly-pharmacy for various comorbidities and concurrent use of modern medicine with CAM, makes this age group particularly prone to adverse effects of drugs and the drug-drug interactions. Use of CAM assumes further importance in the context of Indian elderly, due to the widespread belief in traditional medicines and easy over-the-counter availability of many prescription drugs in India. Aims and Objective: The study was conducted to understand and analyze the knowledge, attitude, and perception of CAM usage specifically in elderly Indian patients, which to the best of our knowledge has yet not been assessed previously. Materials and Methods: It was a descriptive cross-sectional study assessing a representative sample of 325 elderly patients over the age of 60 years. Data collection was done after face-to-face interview-based survey administered on a semi-structured questionnaire. Results: The number of CAM users (65.5%) was significantly more than the non-users (P ≤ 0.05). In the age group between 60 and 69 years, 59% had used CAM, as compared to a significantly more number of 76% patients (P ≤ 0.05), in the age group above 70 years. The CAM practice in the elderly was not influenced significantly by gender, education, rural or urban background, and distance from the health-care facility of modern medicine system. CAM was the initial choice of therapy for 65.7% of the users. Ayurveda was the most popular practice (64.8%), followed by homeopathy (62.4%) with many patients using both the practices together. Use of CAM practices concomitantly with modern medicine was not considered unsafe by 56.8% of patients. The physicians of modern medicine did not ask 91.5% of elderly patients about CAM usage and 85.5% of patients did not volunteer any information on CAM usage unless asked for. Conclusions: The study suggests the need to acknowledge and explore the high prevalence of CAM usage with increasing age in the Indian elderly, both to identify the irrational usage of CAM alone or in combination with the modern medicine system and to facilitate the integration of rational CAM practices in the mainstream medicine.

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“…Literature has been showing that polypharmacy is significantly associated with the occurrence of adverse drug reactions 7,[14][15][16] . It was confirmed in our study findings showing a relationship between the number of drugs prescribed and occurrence of ADRs.…”

Section: Resultsmentioning

confidence: 99%

Untitled

2017

IJPSR

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Background: Understanding the association of risk factors to adverse drug reactions is very important to all healthcare professionals for the development of appropriate preventive strategies for better health care. Objectives: To identify and evaluate the risk factors associated with adverse drug reactions developed in the hospitalized patients of different departments. Methods: A prospective-retrospective study was conducted in a tertiary care hospital for a period of twenty two months, with a specific criterion. Multiple logistic regression analysis was used. Risk factors included provisional diagnoses, suspected drugs which were classified according to ICD-10 classification and therapeutic classification respectively and also subjects' age groups and gender were included. Results: A total of 204 cases' were identified with adverse drug reactions during the period of study for which 1:1 ratio of controls were taken. During the study 175 subjects developed single ADRs (adverse drug reactions) and 29 had multiple ADRs. Causality assessment and severity of reactions were evaluated by using standard scales. Greater association to ADR were shown in the age group of 61-70 years (OR 5.263 95 CI (29.693-0.935)) and males were more likely to experience ADRs. Polypharmacy was identified as major risk factor in the development of adverse drug reactions. Conclusion: In order to minimize the risk of ADRs, early detection and awareness of risk factors plays an important role. Healthcare team should pay more attention in vulnerable age groups and to reduce the irrational drug prescriptions for better patient healthcare.

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Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Cited by 25 publications

References 19 publications

Evaluation of Predisposing Factors Associated with Suspected Adverse Drug Reactions of Hospitalized Patients

Evaluation of Predisposing Factors Associated with Suspected Adverse Drug Reactions of Hospitalized Patients

Use of complementary and alternative medicines in Indian elderly patients

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