Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients

Alkan, Ali; Yaşar, Arzu; Karcı, Ebru; Köksoy, Elif Berna; ÜRÜN, Muslih; Şenler, Filiz Çay; Ürün, Yüksel; Tuncay, Gülseren; Ergün, Hakan; Akbulut, Hakan

doi:10.1007/s00520-016-3409-6

Cited by 60 publications

(50 citation statements)

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“…Several previous studies simultaneously assessed polypharmacy, PIM use, and DDIs in older adults with cancer. Alkan et al reported frequencies of 30.8% polypharmacy, 35.1% severe drug interactions, and 26.6% PIM use in 445 older patients with cancer (286 outpatients and 159 inpatients). Only 38.1% of the participants had metastatic cancer in this study, and approximately 30% of the patients did not receive chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we assessed potential DDIs during the period of chemotherapy. DDIs were screened using the well‐validated clinical software system Lexi‐comp Drug Interactions (Lexi‐Comp, Inc., Hudson, OH) and reviewed by a clinical pharmacist. This system categorizes DDIs into five subgroups and provides clinical recommendations.…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

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Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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Background Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. Subjects, Materials, and Methods This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses. Results In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18–2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity. Conclusion Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. Implications for Practice This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Subjects Materials and Methodsmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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“…Potentially inappropriate medications (PIMs) are classes of drugs whose risks may potentially outweigh their benefits [1]. Despite evidence of negative outcomes in older adults, healthcare practitioners continue to prescribe PIMs [2] to the extent that it has now become a public health concern because of its association with increased morbidity, hospitalization, and mortality [3][4][5][6]. The prevalence of PIM use in older adult populations in both developed and developing countries is very high.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Potentially Inappropriate Medication Prescription Among Older Adults: A Cross-Sectional Study in the State of Qatar

Al-Dahshan

Kehyayan

2020

Drugs - Real World Outcomes

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Background Potentially inappropriate medications (PIMs) often lead to sub-optimal or poor health outcomes in older adults. Objective The objective of this study was to determine the prevalence and predictors of PIM prescription among older adults in Qatar. Patients and Methods This was a cross-sectional, retrospective study using data from the electronic medical records of Qatari patients (age ≥ 65 years) attending the 23 primary healthcare (PHC) centers in Qatar from April 1, 2017 to September 30, 2017. PIMs were identified based on the Beers 2015 criteria: (1) medications to avoid for many or most older adults, and (2) medications to be used with caution in older adults. Descriptive statistics were used to estimate the prevalence of PIM prescription; multivariable logistic regression analysis was performed to identify predictors of PIM prescription among the study population. Results 5639 older adults were included with a mean age of 72.8 (± 6.5) years; 53.8% were females. The prevalence of PIMs that should be avoided was 60.7%, with the most prevalent ones being gastrointestinal (84.2%), pain (49.9%), and central nervous system (10.4%) drugs. Most patients (61.1%) were prescribed one PIM, 26.9% two PIMs, and 12.0% three or more PIMs. The prevalence of PIMs that should be used with caution was 40.6%, with diuretics (83.1%), antidepressants (25.7%), and antiplatelets (18.3%) as the most prevalent drug classes. Multivariable logistic regression showed female gender, polypharmacy, and certain comorbidities to be significant predictors of PIM prescription. Conclusions Older adults attending Qatar’s 23 PHC centers are prescribed a high number of PIMs. Because of the high risk of PIM prescription, the practice of medication reconciliation should be strengthened and reinforced. Electronic supplementary material The online version of this article (10.1007/s40801-020-00220-9) contains supplementary material, which is available to authorized users.

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“…Outro achado significativo foi a maior taxa de interação medicamentosa no grupo de pacientes que utilizavam ao menos uma droga inapropriada (p < 0,001), assim como descrito na literatura. 8, 30 Diante das limitações metodológicas deste estudo (observacionais e transversais), não é possível estabelecer riscos objetivos associados às condições estudadas em algumas das variáveis analisadas, porém observa-se uma tendência de significância dos achados, dada a semelhança dos resultados com vários outros estudos da literatura. conclusão Na população estudada, a presença de polifarmácia foi de 56,5% e a de MPI, 46,5%.…”

Section: Resultsunclassified

Polifarmácia e medicamentos potencialmente inapropriados em idosos admitidos em um hospital terciario

Oliveira¹,

Buarque²

2018

Geriatr., Gerontol. Aging

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resuMo OBJETIVO: No Brasil, 70% dos idosos possuem ao menos uma patologia crônica e, destes, 60% usam mais de 4 medicamentos regularmente, constituindo a polifarmácia. Medicamentos potencialmente inapropriados (MPI) são utilizados por 40% dessa população. Tanto a polifarmácia quanto os MPI estão associados a desfechos negativos, como maior frequência de interação medicamentosa, quedas, fragilidade, desnutrição e, em alguns casos, mortalidade. MÉTODO: Estudo transversal retrospectivo em que foram incluídos idosos internados por motivo clínico no hospital da Santa Casa de Misericórdia de Maceió (SCMM) entre março de 2015 e fevereiro de 2016. Foi avaliada a presença de polifarmácia e MPI, correlacionando-os com outras variáveis de interesse. RESULTADOS: Foram analisados 456 prontuários eletrônicos de pacientes com idade média de 83 anos, sendo 71,3% do sexo feminino. O índice de comorbidade de Charlson (ICC) médio foi de 2,38, sendo demência a morbidade mais prevalente (36,6%). Polifarmácia esteve presente em 56,5% dos pacientes e 46,4% tinham ao menos um MPI, sendo mais frequente o uso de antipsicóticos (46,2%), seguidos por benzodiazepínicos (33%). Interação medicamentosa foi detectada em 53,5% dos pacientes. A presença de polifarmácia se correlacionou com MPI (p < 0,001). Além disso, polifarmácia e MPI se correlacionaram com interação medicamentosa (p < 0,01), pior funcionalidade (p < 0,01) e maior ICC (p = 0,015). CONCLUSÃO: Na população estudada, a presença de polifarmácia foi de 56,5% e a de MPI, 46,5%. Ambas se correlacionaram positivamente com a presença de interação medicamentosa, pior funcionalidade e maior ICC. PALAVRAS-CHAVE: saúde do idoso; prescrição inadequada; polimedicação. aBstract OBJECTIVE: In Brazil, 70% of older adults have at least one chronic disease and, of these, 60% use more than four medications regularly, characterizing polypharmacy. Potentially inappropriate medications (PIMs) are used by 40% of this population. Both polypharmacy and PIM use are associated with negative outcomes, such as increased frequency of drug interactions, falls, frailty, malnutrition, and in some cases, death. METHOD: This was a cross-sectional study with retrospective data collection of all older patients admitted for clinical reasons to a tertiary care hospital in Brazil from March 2015 to February 2016. We evaluated patients for the presence of polypharmacy and PIM use, correlating these findings with other variables of interest. RESULTS: The medical records of 456 patients were analyzed. Mean patient age was 83 years, and 71.3% were women. The mean Charlson comorbidity index (CCI) was 2.38, and dementia was the most prevalent comorbidity (36.6%). Polypharmacy was present in 56.5% of patients, and 46.4% of them used at least one PIM. Antipsychotics were the most frequently used PIM (46.2%), followed by benzodiazepines (33.0%). Drug interactions were detected in 53.5% of patients. The presence of polypharmacy was associated with the use of PIMs (p < 0.001). Additionally, both polypharmacy and PIM use were asso...

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Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients

Cited by 60 publications

References 20 publications

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Prevalence and Predictors of Potentially Inappropriate Medication Prescription Among Older Adults: A Cross-Sectional Study in the State of Qatar

Polifarmácia e medicamentos potencialmente inapropriados em idosos admitidos em um hospital terciario

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