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PubMed1995

Polypharmacy.

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Dose-Response Relationship, Drug↗
PubMed1995

Polypharmacy.

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Antipsychotic Agents↗
PubMed2006

Long-term combination antipsychotic treatment in VA patients with schizophrenia.

Treatment guidelines consider antipsychotic monotherapy the standard of care for patients with schizophrenia. However, previous studies have reported widely varying, and sometimes high, rates of antipsychotic polypharmacy. We identified 61,257 VA patients with schizophrenia in fiscal year 2000 who had >or=90 non-institutionalized days and one or more fills of antipsychotic medications. We used criteria of increasing stringency (>or=30, >or=60, or >or=90 overlapping days' supply of antipsychotic medications) and several cross-sectional criteria from previous studies to compare the prevalence of antipsychotic polypharmacy using these definitions. We also describe specific treatment combinations among patients receiving long-term polypharmacy. The prevalence of antipsychotic polypharmacy was 20.0%, 13.1%, and 9.5% when defined by a >or=30, >or=60, or >or=90-day overlap, respectively. Cross-sectional definitions used in previous studies did not identify 32-89% of patients receiving long-term polypharmacy (>or=90 days). In addition, approximately half of patients identified by cross-sectional criteria had only short-term overlaps of antipsychotic medications. Among patients receiving long-term polypharmacy, 74% received a first- and a second-generation agent, 18% received two second-generation agents, and 6% received two first-generation agents. Definitions of polypharmacy that rely on cross-sectional data or narrow observation periods do not accurately identify patients receiving long-term treatment; in this study, only 10% of patients with schizophrenia received combination treatments for >or=90 days. The most commonly used antipsychotic combinations have little support for safety or efficacy. Further research is needed to understand the impact of these treatments on symptoms, side effects, and costs.

Antipsychotic Agents↗
PubMed2006

Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study.

OBJECTIVE: The aim of this study was to describe the changes in medicine use, polypharmacy and excessive polypharmacy between 1998 and 2003 among a cohort of elderly Finns. METHODS: For this prospective follow-up study, a random sample of 700 participants aged >or=75 years was drawn from the City of Kuopio, Finland. Of them, 601 participated in the study at baseline in 1998. The changes in medicine use among the survivors (n=339), who were re-examined in 2003, were recorded and are described here. Statistical significance of changes in medicine use was evaluated by Student's paired-samples and independent-samples t-test and Fisher's exact test. RESULTS: From 1998 to 2003, the mean number of medicines in use per individual increased from 6.3 to 7.5 (p<0.001). The prevalence of polypharmacy (>5 medicines in use) increased from 54% to 67% and excessive polypharmacy (>or=10 medicines in use) from 19% to 28%. The increase was due to increased use of regularly taken medicines, whereas the use of medicines taken as needed decreased during the follow-up in both sexes. At the time of follow-up survey, persons in institutional care used significantly more medicines (10.9) than community-dwelling elderly persons (7.0) (p<0.001). Central nervous system medicines and cardiovascular medicines were the most commonly used medicines in both years. CONCLUSION: The number of medicines and the prevalence of polypharmacy and excessive polypharmacy increases with advancing age. In order to avoid possible harmful effects and to optimize medication it is necessary to assess the medication regimen at regular intervals.

Age Factors↗
PubMed1985

Effect of serum albumin on free fractions of phenobarbital and valproic acid in patients with convulsive seizures.

The free fractions of phenobarbital and valproic acid were assayed with Free-Level system I (Syva) and by an enzymatic immunoassay technique (EMIT) in 186 patients under chronic anti-convulsant therapy at precisely 2 hrs after they had taken the medicine at breakfast. The free fractions of PB ranged from 49 to 53% in monopharmacy and from 50 to 55% in polypharmacy. Those of VPA ranged from 10 to 12% in monopharmacy and from 8 to 11% in polypharmacy. The regression lines of the free fractions in PB monopharmacy and PB polypharmacy against serum albumin concentration indicated a negative correlation. There was no difference between the free fractions in PB monopharmacy and polypharmacy at the same albumin concentration. The regression lines of the free fractions in VPA monopharmacy and polypharmacy against serum albumin concentration indicated a negative correlation. The free fractions of VPA did not vary under a total VPA concentration of 80 micrograms/ml, while those of VPA above a total VPA concentration of 90 micrograms/ml increased with the total concentration, in the monopharmacy groups. On the other hand, free fractions of VPA in the polypharmacy groups did not vary with the total VPA concentration.

Adolescent↗
PubMed2004

Drug prescription for adult frequent attenders in Danish general practice: a population-based study.

PURPOSE: To analyse the association between daytime frequent attendance in general practice and drug use, i.e. type of drug used and prevalence of polypharmacy. METHODS: A population-based cross-sectional study of individual face-to-face contacts with 179 Danish general practices (320 general practitioners, GPs) in the county of Northern Jutland, Denmark and the drug use of the 371 897 inhabitants aged 20 and over. Data on contacts and reimbursed drugs were obtained during the year of 1997 from the Health Insurance Registry. Frequent attenders (FAs) were defined as the 10% most FAs in 12 months. We measured the prevalence difference (PD) and the prevalence ratio (PR) of drug use and polypharmacy (drugs from five or more ATC groups) among FAs. RESULTS: FAs received prescriptions in 95% of the cases and utilised 27% of all prescribed drugs. Compared with the 50% least attending patients, the highest absolute prevalence of drug use among FAs was found for antibiotics (PD: 22.6-34.5), strong analgesics and psychotropics (PD: 16.0-38.5) and cardiovascular (PD: 4.2-46.2), musculoskeletal (PD: 16.3-29) and gastrointestinal drugs (PD: 10.8-39.9). The FAs had an increased PR for receiving a drug (1.1-1.6) and their polypharmacy PD was high (4.0-46.3). The association between frequent attendance and the prevalence of polypharmacy was strong (PR = 6.7-36.7). CONCLUSIONS: Frequent attendance in general practice is strongly associated with drug use and polypharmacy. FAs account for a high proportion of the prescription workload, and some disease groups are very common among FAs.

Adult↗
PubMed2006

Suboptimal medication use and mortality in an older adult community-based cohort: results from the Hispanic EPESE Study.

BACKGROUND: Numerous methods have been used to evaluate medication management quality in older adults; however, their predictive validities are unknown. Major medication quality indicators include polypharmacy, drug-drug interactions, and inappropriate medication use. To date, no study has attempted to evaluate the three approaches systematically or the effect of each approach on mortality in a Hispanic population. Our objective was to evaluate the relationship between polypharmacy, drug-drug interactions, and inappropriate medication use on the mortality of a community-based population of Mexican American older adults. METHODS: We used a life table survival analysis of a longitudinal survey of a representative sample of 3,050 older Mexican Americans of whom 1,823 were taking prescription and over-the-counter medications. RESULTS: After adjustment for relevant covariates, use of more than four different medications (polypharmacy) was independently associated with mortality. The presence of major drug interactions and the use of inappropriate medications were not significantly associated with mortality in our study sample. CONCLUSION: Polypharmacy (>4 medications) is significantly associated with mortality in Mexican American older adults. This community-based study is the first to demonstrate a direct association between polypharmacy and mortality in this population.

Aged↗
PubMed2005

[Is it valid to concurrently use multiple antipsychotics for patients with schizophrenia?].

The role of antipsychotic polypharmacy in the treatment of schizophrenia remains largely unknown, although such a mode of therapy has frequently been advocated on an empirical basis. This trend has especially been true in Japan. We briefly review current evidence in favor of and against polypharmacy in schizophrenia, then we show the data of revising antipsychotic polypharmacy to monotherapy. The study included 47 patients with chronic schizophrenia. Among the 44 patients assessable, 24 remained stable, 10 got better and 10 got worse after 24 weeks of maintenance monotherapy with the main agent. Overall, there were no significant differences in the Global Assessment of Functioning and the Global Impression of the participants. Conversion to antipsychotic monotherapy was feasible in 22 patients, while another 12 needed low dosages of low-potency agents. The chlorpromazine equivalent amount of antipsychotics was significantly reduced from 1,171 to 952 mg/day in 34 patients who were successful in switching. Although the procedure overall did not help patients much, it is suggested that many instances of antipsychotic polypharmacy are avoidable. Adding medications upon the emergence of symptoms might be an easy way to treat patients. Such an action should be validated in every case, however, and polypharmacy should be tested against prolonged, tenacious monotherapy.

Antipsychotic Agents↗
PubMedDate not supplied

Is 2-propyl-4-pentenoic acid, a hepatotoxic metabolite of valproate, responsible for valproate-induced hyperammonemia?

To investigate the association between valproate metabolism (VPA) and VPA-induced hyperammonemia together with the contribution of VPA hepatotoxicity risk factors such as young age, polypharmacy, and high serum VPA levels to VPA-induced hyperammonemia, plasma ammonia (NH3) levels, serum levels of VPA and its metabolites, and biochemical parameters were determined in 98 patients treated with VPA (53 monopharmacy cases and 45 polypharmacy cases). In monopharmacy patients, plasma NH3 levels did not depend on age, VPA dosage or serum levels. Serum level of 2-propyl-4-pentenoic acid (4-en) showed a negative correlation with plasma NH3 level in the monopharmacy group. In polypharmacy patients, plasma NH3 levels, serum glutamic pyruvic transaminase, and gamma-glutamyl-transpeptidase were significantly higher, while level/dose VPA ratio, 2-en-VPA serum level, and bilirubin were significantly lower than those in monopharmacy patients. These results suggest that young age and relatively high VPA serum levels within the therapeutic range were unlikely to be risk factors for common hyperammonemia associated with VPA therapy and that 4-en was not causally related to this adverse effect. The decreased serum level of 2-en-VPA in polypharmacy patients may be a reflection of a certain mitochondrial dysfunction, which might be a mechanism of the increased NH3 levels. The changes in biochemical parameters in polypharmacy patients were considered results of the enzyme-inducing activity of coadministered antiepileptic drugs (AEDs).

Adolescent↗