Severe potential drug-drug interactions in older adults with dementia and associated factors

Abstract

OBJECTIVE:To identify the main severe potential drug-drug interactions in older adults with dementia and to examine the factors associated with these interactions.METHOD:This was a cross-sectional study. The enrolled patients were selected from six geriatrics clinics of tertiary care hospitals across Mexico City. The patients had received a clinical diagnosis of dementia based on the current standards and were further divided into the following two groups: those with severe drug-drug interactions (contraindicated/severe) (n=64) and those with non-severe drug-drug interactions (moderate/minor/absent) (n=117). Additional socio-demographic, clinical and caregiver data were included.Potential drug-drug interactions were identified using Micromedex Drug Reax 2.0® database.RESULTS: A total of 181 patients were enrolled, including 57 men (31.5%) and 124 women (68.5%) with a mean age of 80.11±8.28 years. One hundred and seven (59.1%) patients in our population had potential drug-drug interactions, of which 64 (59.81%) were severe/contraindicated. The main severe potential drug-drug interactions were caused by the combinations citalopram/anti-platelet (11.6%), clopidogrel/omeprazole (6.1%), and clopidogrel/aspirin (5.5%). Depression, the use of a higher number of medications, dementia severity and caregiver burden were the most significant factors associated with severe potential drug-drug interactions.CONCLUSIONS:Older people with dementia experience many severe potential drug-drug interactions. Anti-depressants, antiplatelets, anti-psychotics and omeprazole were the drugs most commonly involved in these interactions. Despite their frequent use, anti-dementia drugs were not involved in severe potential drug-drug interactions. The number and type of medications taken, dementia severity and depression in patients in addition to caregiver burden should be considered to avoid possible drug interactions in this population.

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

“…In fact, diuretics and cardiovascular agents (eg, beta blockers or calcium channel blockers) were most frequently involved in adverse events leading to unscheduled hospitalizations . Moreover, anticoagulants were involved in potential drug‐drug interactions in 23% of hospitalized older adults with dementia …”

Clinically relevant drug–drug interactions among elderly people with dementia

“…Many hospitalisations caused by DDIs could be avoided [ 11 ]. Increased risk of bleeding, prolongation of QT interval and hyperkalaemia are examples of the consequences of DDIs that expose elderly people with dementia to unnecessary risks if drug use is not properly monitored [ 12 , 13 ].…”

Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

“…The combination of low‐dose aspirin with clopidogrel and/or anticoagulants is commonly prescribed in combination to elderly patients for preventing atherothrombotic events. Multiple studies have reported these interactions to be responsible for serious bleeds . There are significant financial consequences associated with inappropriate DDIs in emerging nations such as Pakistan which struggle to provide the most basic of medical amenities to a large population .…”

“…Multiple studies have reported these interactions to be responsible for serious bleeds. [54][55][56] There are significant financial consequences associated with inappropriate DDIs in emerging nations such as Pakistan which struggle to provide the most basic of medical amenities to a large population. [57] Through close monitoring of patients, appropriate selection of drugs and prescribing within the target DDD numerous DDIs occurring in the hospitalized elderly could be halted in Pakistan.…”