Prevalence of the potentially inappropriate Kampo medications to be used with caution among elderly patients taking any prescribed Kampo medications at a single centre in Japan: a retrospective cross-sectional study

Abstract

BackgroundFew studies have investigated the prevalence and characteristics of potentially inappropriate Kampo medication use among elderly ambulatory patients taking any prescribed Kampo medications.MethodsA retrospective cross-sectional study was conducted using electronic medical records. All patients aged 65 years or older who continued visiting internal medicine physicians and were prescribed any Kampo medications from January 2015 to March 2015 were included. The primary outcome was the proportion of patients taking any potentially inappropriate Kampo medications that should be used with caution (hereafter referred to as UWC Kampo medications). The medication appropriateness was evaluated based on the 2015 Japan Geriatrics Society guidelines.ResultsEighty eligible patients were identified. The mean age was 76.7 years, 45 patients (56.2%) were female, the mean Charlson Comorbidity Index was 1.7, the median number of non-Kampo medications used was 5.0, and the median number of Kampo medications used was 1.0. The proportion of patients taking any UWC Kampo medications was 28.8% (95% confidence interval, 18.6 to 38.9%). Medications containing Glycyrrhizae radix for chronic kidney disease or loop diuretics were the most common UWC Kampo medications. Compared with patients who did not take any UWC Kampo medications, patients who did take such medications used aconite compositions more frequently (p = 0.04) and were more likely to have uncontrolled hypertension (p = 0.02) and chronic kidney disease (p < 0.001). In a multivariable analysis, no predictive factors for the use of UWC Kampo medications were identified.ConclusionsApproximately one-fourth of the elderly patients taking any prescribed Kampo medications took at least one UWC Kampo medication, although the association between UWC Kampo medications and adverse events remains unclear. When physicians prescribe medications containing Glycyrrhizae radix to elderly patients, chronic kidney disease and the use of loop diuretics should be evaluated.

Prevalence of hospitalisation caused by adverse drug reactions at an internal medicine ward of a single centre in Japan: a cross-sectional study

“…Therefore, this finding may be specific to Japan where herbal medications are often prescribed by physicians 16. Given that the potentially inappropriate use of traditional Japanese herbal medication among elderly patients may be common in Japan,17 our findings suggest that a strategy to improve the appropriateness of herbal medication use is needed. Moreover, given that accurate data on the safety of herbal medication use are lacking,18 monitoring the adverse events of herbal medications is also needed 19…”

Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services

“…Kampo is used by the elderly as a supplementary treatment to maintain mental and physical wellbeing [54]. A retrospective cross-sectional study in Japan reported that Glycyrrhizae radix , the most commonly used component of Kampo, was potentially associated with chronic kidney disease and uncontrolled hypertension in elderly patients [55]. This unconfirmed relationship is worthy of further exploration and evaluation.…”

The use of Kampo medications that may cause heart failure in hospitalized acute heart failure patients in a Japanese hospital

“…Therefore, assuming that the proportion of patients who used CEHF Kampo medications was 6%, based on a previous study to determine the prevalence of potentially inappropriate use of Kampo medications among elderly patients in outpatient settings, 8 approximately 400 acute heart failure patients were needed to provide a precision of 3% for the calculation of the 95% confidence intervals (CIs) of the primary outcomes.…”

“…Nonetheless, the inappropriate use of prescribed Kampo medications might be common in Japan. 8 Certain components of Kampo medications can be harmful to cardiac function. [9][10][11][12][13][14][15][16] For example, licorice can cause heart failure through sodium retention.…”