Polypharmacy in Parkinson’s disease: risks and benefits with little evidence

Csóti, Ilona; Herbst, Heinz; Woitalla, Dirk; Wüllner, Ullrich

doi:10.1007/s00702-019-02026-8

Cited by 20 publications

(17 citation statements)

References 41 publications

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“…On the other hand, the greater number of administered drugs in our cohort could be the reason for the higher amount of relevant interactions. The complex treatment of PD and associated comorbidities often requires the administration of several different drugs, thus leads to considerable polypharmacy and provides higher interaction potential (McLean et al 2017;Müller-Rebstein et al 2017;Csoti et al 2019).…”

Section: Severitymentioning

confidence: 99%

Drug safety profiles in geriatric patients with Parkinson’s disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

et al. 2020

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To reduce potentially inappropriate medications, the FORTA (Fit fOR The Aged) concept classifies drugs in terms of their suitability for geriatric patients with different labels, namely A (indispensable), B (beneficial), C (questionable), and D (avoid). The aims of our study were to assess the medication appropriateness in PD inpatients applying the FORTA list and drug-drug interaction software, further to assess the adequacy of FORTA list for patients with PD. We retrospectively collected demographic data, comorbidities, laboratory values, and the medication from the discharge letters of 123 geriatric inpatients with PD at the university hospital of Hannover Medical School. Patients suffered on average from 8.2 comorbidities. The majority of the medication was labeled A (60.6% of PD-specific and 40.9% of other medication) or B (22.3% of PD-specific and 26.9% of other medication). Administered drugs labeled with D were amantadine, clozapine, oxazepam, lorazepam, amitriptyline, and clonidine. Overall, 545 interactions were identified, thereof 11.9% severe interactions, and 1.7% contraindicated combinations. 81.3% of patients had at least one moderate or severe interaction. The FORTA list gives rational recommendations for PD-specific and other medication, especially for general practitioners. Considering the demographic characteristics and the common multimorbidity of geriatric PD patients, this study underlines the importance of awareness, education, and preventive interventions to increase drug safety.

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Section: Severitymentioning

confidence: 99%

Drug safety profiles in geriatric patients with Parkinson’s disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

et al. 2020

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“…A recent prospective study on 127 PD patients with advanced PD, including some with DAT, found that interactions most frequently involved central nervous system–active substances (mainly opioids, neuroleptics, benzodiazepines, and antidepressants) with l ‐dopa, followed by pramipexole and rotigotine 43 . The fact that we found that PD‐related medications diminished up to 4 years after DAT, despite a presumed progression of disease, is therefore clinically relevant, given that it could diminish the risk of harmful drug interactions 44 …”

Section: Discussionmentioning

confidence: 60%

Access and Use of Device‐Aided Therapies for Parkinson’s Disease in Denmark

Henriksen

Dalhoff

Hansen

et al. 2020

Movement Disord Clin Pract

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Background In Denmark’s five regions, there is potential inequality in access to device‐aided therapy (DAT) for Parkinson’s disease (PD) based on structural or socioeconomic factors. It is unclear how long DAT is maintained and affects concomitant medication. Objectives To investigate access to DAT by comparing the proportion of patients with DBS, subcutaneous apomorphine infusion (SCAI), or levodopa/carbidopa intestinal gel (LCIG) in Danish regions 2008–2016 and describe demographics of patients, changes in use of comedication, and maintenance of DAT. Methods This work is a retrospective nationwide population‐based registry analysis generated by combining various registries and statistics in Denmark. Results From 2008 to 2016, 612 patients started DAT. There were statistically significant differences in the number of patients starting DAT between the Capital Region (99.5 per 1,000) and both Central Jutland (66.6 per 1,000) and North Jutland (70.6 per 1,000; P < 0.05). Among DBS and LCIG patients, respectively, 4% and 42% were aged ≥70 years, 68% and 63% were men (vs. 59% in the general PD population; P < 0.05 for DBS), 73% and 63% had a partner (vs. 62% in the general PD population), and 73% and 71% had a qualifying education (vs. 63% in the general PD population; P < 0.05). Use of PD‐related medication decreased significantly from 4 years before to 4 years after DAT. Eighty‐one percent of the patients who started LCIG, alive 4 years later, had maintained this treatment. Conclusions There is unequal access to DAT in the Danish regions, and political and social considerations are warranted to address structural and socioeconomic causes.

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“…Dopamine agonists have been related to severe neuropsychiatric complications (impulse control disorders, psychosis) whose severity depends partly on dose levels. Amantadine use in PD is related to a higher risk of severe cardiac arrhythmias when combined with antipsychotics and tri-and tetracyclic antidepressants, it increases pramipexole blood levels and CNS toxicity because of common renal excretion, and its anticholinergic effects may impair cognitive function and trigger psychotic episodes in elderly patients [47].…”

Section: Discussionmentioning

confidence: 99%

A Spanish Consensus on the Use of Safinamide for Parkinson’s Disease in Clinical Practice

et al. 2020

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Safinamide is an approved drug for the treatment of motor fluctuations in Parkinson’s disease (PD). Scarce data are available on its use in clinical practice. A group of Spanish movement disorders specialists was convened to review the use of safinamide across different clinical scenarios that may guide neurologists in clinical practice. Eight specialists with recognized expertise in PD management elaborated the statements based on available evidence in the literature and on their clinical experience. The RAND/UCLA method was carried, with final conclusions accepted after a 2-round modified Delphi process. Higher level of agreement between panellists was reached for the following statements. Safinamide significantly improves mean daily OFF time without troublesome dyskinesias. Adjunctive treatment with safinamide is associated with motor improvements in patients with mid-to-late PD. The efficacy of safinamide on motor fluctuations is maintained at long-term, with no increase over time in dyskinesias severity. The clinical benefits of safinamide on pain and depression remain unclear. Safinamide presents a similar incidence of adverse events compared with placebo. The efficacy and safety of safinamide shown in the pivotal clinical trials are reproduced in clinical practice, with improvement of parkinsonian symptoms, decrease of daily OFF time, control of dyskinesias at the long term, and good tolerability and safety.

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Polypharmacy in Parkinson’s disease: risks and benefits with little evidence

Cited by 20 publications

References 41 publications

Drug safety profiles in geriatric patients with Parkinson’s disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

Drug safety profiles in geriatric patients with Parkinson’s disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

Access and Use of Device‐Aided Therapies for Parkinson’s Disease in Denmark

A Spanish Consensus on the Use of Safinamide for Parkinson’s Disease in Clinical Practice

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