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At least 253 records · Page 14Linked to original sources
PubMed1998

Polypharmacy and the risk of drug-drug interactions among Danish elderly. A prescription database study.

OBJECTIVE: To analyze the use of all subsidized prescription drugs with special attention to the elderly (> or = 70 years of age), including their use of drug combination generally accepted as carrying a risk of severe interactions. DESIGN: Descriptive prevalence study. SETTING: Odense Pharmacoepidemiological Database, Denmark. The fourth quarter of 1994. SUBJECTS: All inhabitants in the county of Funen, Denmark. MAIN OUTCOME MEASURES: Prevalence of drug use for persons < 70 and > or = 70 years of age including number of drugs used and of drug combinations. Occurrence of 45 drug combinations generally accepted as carrying a risk of severe interactions. RESULTS: Among persons less than 70 years, 67.9% used none, 16.5% used one drug and 15.6% used two or more prescription drugs. The corresponding prevalences for the elderly were 35.7%, 15.9% and 48.4%. The 26,337 elderly patients with at least two drugs used 21,293 different combinations. Of the elderly patients who had purchased > or = two drugs, 4.4% had combinations of drugs carrying a risk of severe interactions. CONCLUSIONS: Most elderly use drugs and usually several drugs concomitantly. The elderly form a heterogeneous group of drug users. Drug combinations carrying a risk of severe interactions are relatively frequent.

Aged↗
PubMed2003

Microemulsion electrokinetic chromatography applied for separation of levetiracetam from other antiepileptic drugs in polypharmacy.

Microemulsion electrokinetic chromatography was applied for the separation of levetiracetam from other antiepileptic drugs (primidone, phenobarbital, phenytoin, lamotrigine and carbamazepine) that are potentially coadministered in therapy of patients. The influence of the composition of the microemulsion system (with sodium dodecyl sulfate as charged surfactant) was investigated, modifying the kind of cosurfactant (lower alcohols from C3 to C5), the pH (and salinity) of the aqueous background electrolyte, and the ratio of aqueous phase to organic constituents forming the microdroplets of the oil-in-water emulsion. Separation selectivity was depending on all these parameters, resulting even in changes of the migration sequence of the analytes. Only moderate correlation was observed for the microemulsion system compared with a micellar system, both consisting of the aqueous borate buffer (pH 9.2) and SDS as micelle former (linear correlation coefficient for analyte mobilities is 0.974). The sample solvent plays an important role on the shape of the resulting chromatograms: methanol at concentrations higher than 35% impairs peak shape and separation efficiency. The microemulsion method (with 93.76% aqueous borate buffer (pH 9.2, 10 mM), 0.48% n-octane, 1.80% SDS, 3.96% 1-butanol, all w/w) is suitable for the determination of levetiracetam in human plasma (combined with a sample pretreatment based on solid-phase extraction).

Anticonvulsants↗
PubMed1994

Physical comorbidity and polypharmacy in older psychiatric patients.

We compared three groups of older psychiatric outpatients on numbers and types of physical illnesses and on number of nonpsychotropic medications. The subjects included 62 patients with Alzheimer's disease (AD), 41 with major depression (MD), and 78 with schizophrenia (SZ). The mean age in this predominantly male population was 68.4 years. Psychiatric diagnoses were based on DSM-III-R criteria. We utilized intake psychiatric assessments, chart reviews, and computerized pharmacy profiles to collect the data. The patients with SZ had significantly lower comorbidity compared to patients with MD, and had a significantly lower number of nonpsychotropic medications prescribed than both the AD and MD groups. These findings may reflect biological differences or may be secondary to differences in psychiatric treatment or in the use of health care resources. Alternatively, the low prevalence of physical comorbidity in SZ may represent a survivor or healthier cohort of patients.

Aged↗
PubMed2005

The impact of risk status, preexisting morbidity, and polypharmacy on treatment decisions concerning menopausal symptoms.

Because each menopausal treatment has a unique benefit-risk profile, deciding whether menopausal hormone therapy (HT) or another menopausal treatment is appropriate for an individual requires assessing the risks and benefits of each treatment as well as determining the patient's risk factors, comorbidities, and current medications. Simple summary metrics for assessing net treatment effects on multiple outcomes, such as the Women's Health Initiative's (WHI) global index, are not necessarily generalizable beyond the study population in which they were derived. However, trial evidence can be translated to individual decisions by transforming relative risks into absolute risks. The validity of generalizing relative risks found in clinical trials to groups with differing baseline risks depends on the homogeneity of relative risks across various risk strata. Subgroup analyses from the major clinical studies of HT found its relative risks for cardiovascular disease, hip fracture, breast cancer, colorectal cancer, and ovarian cancer to be relatively uniform across strata defined by age, race/ethnicity, antecedent risk status, or prior disease. The number of significant subgroup findings in these studies tended to match the number expected by chance alone. However, data are limited for many subgroups, especially those with comorbidities. Strata defined by the concurrent use of drugs that can interact with HT are not expected to be homogeneous, yet data on drug interactions are limited. More data are needed about the effects of menopausal treatments in diverse populations, and more attention is needed to translate this evidence into clinical practice and to develop tools to support informed decision making.

Estrogen Replacement Therapy↗
PubMed2002

Prevalence and patterns of concomitant use of selective serotonin reuptake inhibitors and other antidepressants in a high-cost polypharmacy cohort.

BACKGROUND: Concomitant antidepressant therapy for patients who do not respond to selective serotonin reuptake inhibitors (SSRIs) may be appropriate under close medical supervision. However, little is known about the prevalence or patterns of concurrent antidepressant therapy in a typical large health maintenance organization. OBJECTIVE: The purpose of this study was to determine the prevalence of concomitant SSRI-antidepressant therapy and to assess the relationship between concomitant SSRI therapy, patient demographic characteristics, and the use of multiple prescribers and pharmacies. METHODS: This was a retrospective analysis of administrative prescription and medical claims data from January 1998 through September 1999. Data were obtained on beneficiaries who had >15 prescriptions dispensed in either of the first 2 quarters of 1999 and/or patients who accrued >$1,000 in prescription costs in either or both of the quarters. Patients were defined as undergoing concomitant SSRI therapy if they had received > or = 14 days of concomitant treatment with 2 SSRIs, an SSRI and tricyclic antidepressant, an SSRI and benzodiazepine, or an SSRI and miscellaneous antidepressant. Contingency analysis and logistic regression were used to identify factors associated with concomitant SSRI therapy. RESULTS: The relative risk for concomitant SSRI-SSRI therapy for patients with multiple prescribers versus a single prescriber was 2.32; the relative risk for patients receiving prescriptions from multiple pharmacies versus a single pharmacy was 2.97. Female patients were 19.8% more likely than male patients to receive concomitant SSRI therapy. Use of multiple prescribers increased the odds for concomitant SSRI therapy by >3.0 across the 4 therapeutic combinations. Use of multiple pharmacies increased the odds for concomitant SSRI-SSRI therapy by 5.42. CONCLUSIONS: Prescription of concomitant SSRI therapy was strongly associated with changes in strength of dosage and products and with use of multiple prescribers and pharmacies.

Antidepressive Agents, Second-Generation↗
PubMed1995

Rational polypharmacy.

The development of assays for plasma antiepileptic drug concentrations has led to the discovery of many pharmacokinetic interactions, some causing drug intoxication and others resulting in ineffective drug concentrations. In the 1970s, a number of epileptologists began to argue that single drug therapy was desirable in the treatment of epilepsy and this has become the accepted policy when initiating therapy. About 75% of patients treated in this way will achieve remission with a minimum of adverse drug reactions. The remainder, however, continue to have unacceptable seizures and usually receive combinations of drugs. Evidence indicates that the response rate on adding a second drug is low, although in some studies of new drugs such as vigabatrin up to one-half of patients receiving add-on therapy experience a 50% or greater reduction in seizure frequency, and 10-15% are seizure-free in the short term. Unfortunately, randomized placebo-controlled studies have not been undertaken to compare the relative merits of monotherapy and combination therapy with respect of seizure control and adverse effects. It is argued that the time has come to do so, particularly in view of the known mode of action of some of the new drugs. Perhaps blocking excitation with one drug at the same time as enhancing inhibition with another may be better than doing only one or the other.

Anticonvulsants↗