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Results for “Polypharmacy”

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PubMed2005

Polypharmacy treatment approaches to the psychiatric and somatic comorbidities found in patients with chronic pain.

This review outlines the following: psychiatric and somatic comorbidities associated with chronic pain and their relationship to polypharmacy treatment, indications for polypharmacy in chronic pain, criteria for rational polypharmacy, basic principles of polypharmacy for pain-associated comorbidity, and, based on the above, psychopharmacologic polypharmacy treatment approaches to these chronic pain-associated comorbidities.

Chronic Disease↗

PubMedDate not supplied

Reduction of polypharmacy by feedback to clinicians.

OBJECTIVE: To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center. DESIGN: 292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104). SETTING: Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center. PATIENTS/PARTICIPANTS: All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male. INTERVENTIONS: The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention. MEASUREMENTS AND MAIN RESULTS: Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant. CONCLUSIONS: A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.

Colorado↗

PubMed1997

Polypharmacy in the Older Patient With Cancer.

BACKGROUND: Elderly patients -- those aged 65 years and over -- use more medications than their younger counterparts and experience higher risks for polypharmacy, drug interactions, adverse drug reactions, and noncompliance for this age-group. METHODS: The data on polypharmacy in the aged is reviewed, supplemented with preliminary information from studies performed on elderly patients with cancer at our institution. RESULTS: Polypharmacy occurs in ambulatory, extended care, and institutional settings. Over-the-counter medications are underreported. The number of potential drug-related problems is related to the total number of prescriptions. Methods for evaluating the extent of polypharmacy include the "brown-bag" technique and careful medication histories. CONCLUSIONS: The risks of polypharmacy may be reduced with patient and physician education, intervention, and drug monitoring. Further pharmacokinetic investigations of anticancer medications are needed to recognize the potential for harmful drug interactions, to understand their toxicity profiles, and to avoid the clinical implications of drug interactions.

Journal Article↗

PubMedDate not supplied

Effect of anti-epileptic drug monotherapy and polypharmacy on visual and auditory evoked potentials.

Previous reports have suggested that some anticonvulsants may prolong somatosensory and auditory evoked potential latencies. We compared pattern-reversal visual and brainstem auditory evoked potentials in normal controls, patients on monotherapy, and patients taking polypharmacy. Visual evoked potential amplitudes were less in seizure patients, and P1 latencies were longer in epileptics on polypharmacy than controls. Absolute latencies of brainstem auditory evoked potentials were longer in polypharmacy patients than in controls or monotherapy patients. I-III, III-V, and I-V interpeak latencies were greater in polypharmacy patients than in those on monotherapy or controls. These findings suggest that anticonvulsants may affect conduction along visual and auditory pathways, and that antiepileptic drug polypharmacy and monotherapy may differ in their effects.

Adolescent↗

PubMed1999

Adverse drug reactions and polypharmacy in the elderly in general practice.

OBJECTIVES: The risk of adverse drug reactions (ADRs) increases with the number of drugs used. Most studies refer to potential interactions; the results regarding the severity of occurring and registered ADRs are inconsistent. Therefore, we examined the relevance of drug-induced problems in the elderly in general practice and their association with polypharmacy. DESIGN: Retrospective cross-sectional analysis of prospectively collected data. SETTING: Three family practices participating in the medication and morbidity Registration Network Groningen (RNG). METHODS: From 2185 elderly patients (>64 years) medication and morbidity data were collected over the period of 2 years (1994 and 1995). Polypharmacy was defined as the long-term simultaneous use of two or more drugs. Adverse reactions recognised as such were coded as a separate 'diagnosis' A85. The most risky drug groups and the most prevalent diseases in relation to ADRs were studied. RESULTS: The incidence of ADRs in general practice was 5.7 per 100 elderly patients and the prevalence 6.1 per 100. Moderate polypharmacy was more frequent in the elderly who experienced adverse effects; no other differences in degree of polypharmacy could be found. The elderly who experienced adverse reactions used overall more different drugs (14.4 +/- 7.6, of which 1.5 +/- 1.5 were used long term) than the other elderly patients (8.1 +/- 5.7, of which 1.0 +/- 1.5 were long term). The incidence of ADRs increased non-significantly with the number of drugs used long term. Antibiotics, antihypertensives and non-steroidal anti-inflammatory drugs were mainly responsible for gastrointestinal complaints (nausea, diarrhoea and stomach pain) and rash. In the cases of treating urinary tract infections and sleeping disorders, there was a significantly high risk of ADRs. Slightly more at risk for adverse drug reactions were older patients with coronary heart disease or asthma/chronic obstructive pulmonary disease. CONCLUSION: Most of the ADRs observed in general practice turn out to be rather harmless. This is in agreement with outpatient studies, though not with hospital studies. An increased risk of adverse effects with the number of drugs used simultaneously, as reported in other studies, was not confirmed in our study. This study however is limited to actually registered effects.

Abdominal Pain↗

PubMed2003

Therapy related hospital admission in patients on polypharmacy in Singapore: a pilot study.

OBJECTIVE: To estimate the incidence of drug-related problems (DRPs)-associated hospital admission, and its correlation to polypharmacy and age. METHOD: A retrospective, cross-sectional study in in-patients on polypharmacy in Singapore. Significant differences (P < 0.05) between number of medications taken and age of patients were tested with the chi-square test. RESULTS: The study population consisted of 347 patients (aged 16-97) on a mean of 7.4 +/- 2.1 medications. 10.8% of the study population had DRPs on admission: 71.9% of which were dominant reasons for admission, and DRPs contributed partly in the remaining cases. These DRPs were mostly avoidable, and can be broadly classified into non-compliance, adverse drug reactions, require synergistic therapy, inappropriate dose and untreated condition. 52% of these cases were made up of geriatric patients. No statistical difference was found between patients on polypharmacy and those on major polypharmacy (10 and more drugs) in having a DRP. CONCLUSION: In this study, DRPs contributing to hospital admission appeared to be avoidable. Geriatrics were more susceptible to DRPs and future efforts are required in managing medications prescribed for these patients to reduce such incidences.

Adolescent↗

PubMed2006

Escalating polypharmacy.

New drug treatments, new indications for older drug treatments, lower thresholds for treating risk factors in preventative medicine, and an ageing population acquiring multiple pathologies all contribute to the development of polypharmacy. Longitudinal studies document the rise in prescribed medications, particularly in the elderly. The potential dangers of adverse drug reactions and interactions, poor adherence and confusion associated with ever-increasing polypharmacy are likely to worsen. Strategies to reduce prescribing will obviously decrease the dangers of polypharmacy. These include more considered prescribing when contemplating additions to patients' already lengthy prescription lists, and external reviews of medicine lists by a doctor or pharmacist. Despite such strategies, polypharmacy seems inevitable and considerations must be given to simplifying patients' multiple drug administrations using single-daily-dose regimens, fixed-dose combination pills, calendar-blister packaging and pill organizers.

Aged↗

PubMed2005

Polypharmacy and possible drug-drug interactions among diabetic patients receiving home health care services.

OBJECTIVES: In this study, we examined the drug regimens of diabetic patients receiving home health care services to measure the prevalence of polypharmacy and to assess the likelihood of drug-drug interactions, a consequence of polypharmacy. DESIGN: The sample consisted of 139 diabetic patients who received home health care services from one home health agency in a large mid-Atlantic city. The data were collected from March 1, 1998 to September 30, 1999. Information regarding medications was collected by the home health nurse during the initial home visit and was recorded on the medication sheet in the patient's clinical record. Any changes in medications were noted on the medication sheets. METHODS: We identified all systemic medications prescribed for 139 home health patients. To assess drug-drug interactions, we used Micromedex formulary DRUG-REAX System. OUTCOMES: We calculated (1) the number of systemic medications taken, and (2) the number of possible severe, moderate, and mild drug-drug interactions. RESULTS: We found that the average number of medications taken was 8.9 (SD 3.4) prescribed medications per day. Our results show that 38.8% of the patients in the sample could potentially be subject to at least one severe drug-drug interaction. Nearly all of the patients (92.8%) were at risk for moderate drug-drug interactions, and 70.5% could have mild drug- drug interactions. CONCLUSION: We conclude that polypharmacy is a concern for home health care patients with diabetes and the potential for drug-drug interactions is substantial. Our results indicate that the drug regimens of diabetic patients should be monitored systematically to avoid adverse events such as hospitalization. Family practitioners and home health care takers are in a unique position to identify polypharmacy and to modify drug regimens.

Aged↗

PubMed2004

A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation.

The atypical antipsychotics risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole have become first-line treatment for schizophrenia because they reduce the positive symptoms of psychosis but do not have a high incidence of extrapyramidal symptoms. However, these agents, like other antipsychotics, may take as long as 16 or more weeks to produce a response, and even with prolonged treatment are unlikely to evoke responses greater than 50% improvement in symptoms. This has led to the experimental use of high atypical antipsychotic doses, antipsychotic polypharmacy, and augmentation with other psychotropic drugs, all of which occur commonly in clinical practice. This article reviews the current evidence for these increasingly common means of treating schizophrenia and psychosis, with particular emphasis on polypharmacy and augmentation. To date, there are only two controlled studies of antipsychotic polypharmacy involving an atypical antipsychotic; the rest of the data are uncontrolled trials and case reports that describe a mixture of positive and negative findings. One multicenter, double-blind trial shows a faster onset of action when divalproex is added to risperidone or olanzapine than with antipsychotic monotherapy. A small double-blind study demonstrates efficacy when lamotrigine is added to clozapine. The rest of the data on augmentation with anticonvulsants are uncontrolled, and most report adverse effects. With the exception of divalproex, there are currently no compelling data to justify the use of antipsychotic polypharmacy or augmentation. Existing evidence suggests that the best treatments for schizophrenia and psychosis may be long-term trials of a sequence of atypical antipsychotic monotherapies at therapeutic doses.

Acetates↗

PubMed1999

[Chronic polypharmacy in one-third of the elderly in family practice].

OBJECTIVE: Description of the extent and nature of polypharmacy in the elderly in general practice. DESIGN: Retrospective cross-sectional study. METHOD: Medication and morbidity data were collected over July-December 1994 on all 2197 patients > or = 65 years registered in 3 family practices connected with the Medication and Morbidity Registration Network Groningen, the Netherlands. Special attention was paid to the simultaneous use of > or = 2 drugs during > or = 120 days in the study period ('chronic use'). Three categories of polypharmacy were distinguished: mild (2-3 drugs), moderate (4-5) and extensive (> 5). RESULTS: Forty per cent of the study group were males; 54% were 65-74 years, 34% were 75-84 years and 12% were > or = 85 years. The mean number of drugs used was 3.9 per person (SD: 3.6), of which 1.4 (SD: 1.8) chronically. Polypharmacy occurred in 35%: mild in 23%, moderate in 8% and extensive in 4%. All occurred mostly in the group between 75 and 84 years old. Cardiovascular drugs, in particular diuretics, and psycholeptics were mostly prescribed concomitantly with each other and with other drugs. The prevalence of concomitant use of drugs with potential interactions was low (< 3%). The indications for psycholeptic drugs were quite often not clear. Congestive heart failure, chronic obstructive pulmonary disease (COPD)/asthma and diabetes mellitus were mainly responsible for extensive polypharmacy.

Aged↗

PubMed2002

Polypharmacy: overdosing on good intentions.

Polypharmacy, the concurrent use of multiple medications, is a growing problem that is more common than most healthcare professionals realize. Most patients are seeing multiple doctors and have multiple prescriptions, therefore making it difficult for physicians to properly monitor their patients. However, there are steps that the healthcare profession can take to reduce the occurrence of polypharmacy. The use of a well-designed polypharmacy intervention program can help reduce the costs associated with polypharmacy, as well as improve patients' health by helping to detect and avoid unnecessary drug use.

Cost Control↗

PubMed2004

Revising polypharmacy to a single antipsychotic regimen for patients with chronic schizophrenia.

Antipsychotic polypharmacy has been empirically used and a recent trend in favour of that mode of therapy has been suggested for the treatment of schizophrenia. The clinical efficacy, however, still remains to be clarified. In order to critically evaluate the usefulness of such kind of psychopharmacotherapy, antipsychotic combination regimen (polypharmacy) was switched to a treatment with the single main antipsychotic (monotherapy) in cross-tapered fashion, while approximately maintaining the total amount, for patients with chronic schizophrenia. Patients had been treated with an average of three antipsychotics and maintained with the same antipsychotic polypharmacy regimen for more than 6 months before the entry. They were followed up with an antipsychotic monopharmacy and evaluated at 24 wk after completion of switching. Forty-seven patients were recruited for this study. Of 44 patients for whom evaluation was possible, 24 (54.5%) remained stable, while 10 (22.7%) showed improvement and the same number of patients ended in a deleterious status. Twenty-two patients were converted to antipsychotic monotherapy, while another 12 needed minimal dosing of low-potency agents. Overall, social functioning, evaluated by the Global Assessment of Functioning and the Clinical Global Impression, remained unchanged. Eighteen of 34 successful patients showed adverse effects of the main antipsychotic medication, which necessitated a significant dose reduction. Nine out of 10 deteriorating patients had been treated with a combination of low- and high-potency antipsychotics. It is suggested that many instances of antipsychotic polypharmacy is avoidable. The result is compatible with the current treatment recommendations, which dictate the use of a single antipsychotic agent.

Adult↗

PubMed2005

[Knowledge on polypharmacy in a group of 65-year-old people or older living in a sector of the metropolitan area of Puerto Rico].

Addressing the high utilization of medications among the elderly, this study explored the degree of knowledge of polypharmacy and its consequences, as well as the pattern of utilization by a group of elders 65 years of age and over in the San Juan metropolitan area of Puerto Rico. A dual technique was utilized: focus groups and a survey. Two focus groups were performed in order to explore issues pertaining the following domains: quality of life, doctor-patient and pharmacist-patient relationships, degree of knowledge of polypharmacy, and need of information. A questionnaire was administered to obtain information regarding their pattern of drug utilization. Results of focus groups indicated that the elderly have learned how to cope with their chronic conditions and be able to continue with quality of life. Additionally, results suggested a need form the elderly to develop more assertiveness and closeness with their health care providers, both doctor and pharmacist; as well as a lack of sufficient knowledge of the serious implications that polypharmacy brings. Results from the survey revealed and confirmed their inappropriate utilization of medications, and suggest that this segment consults multiple physicians, all of which may bring potential problems of adverse drug interactions. Further investigation is needed to examine fully the issue of polypharmacy, as well as the need of education that results in empowerment of patients, families and communities.

Aged↗

PubMed1996

Polypharmacy in multiple sclerosis.

The goal of this article is to describe therapeutic approaches to multiple sclerosis (MS) which may be applicable to other human conditions such as epilepsy. Polypharmacy is very commonly employed in MS and it is likely to increase in the future. This paper is written with the premise that therapeutic principles and practices underlying the care of patients with MS may be useful for the treatment of people with epilepsy. We will point out some of the analogies between MS and epilepsy and we will describe the polypharmacy approach employed to treat patients with MS. We will review current information as to the etiology and pathogenesis of MS and describe potential therapeutic targets derived from this knowledge. We will identify or suggest certain therapeutic principles underlying polypharmacy in MS which may be relevant to epilepsy or other conditions. Finally, we will describe some of the obstacles to expanding rational polypharmacy and how we might overcome these problems.

Brain↗

PubMed2004

Pharmacological treatment in patients with heart failure: patients knowledge and occurrence of polypharmacy, alternative medicine and immunizations.

AIMS: To evaluate in patients with heart failure (HF) due to systolic dysfunction the occurrence of polypharmacy, alternative medicine, immunization against influenza, and patients' knowledge about their medication. METHODS AND RESULTS: Sixty-five patients, 49 men, mean age 60.5+/-12.0 years answered a confidential questionnaire during 2002. Polypharmacy was frequent, 48 (74%) were taking six or more pills per day and 18 (28%) 11 or more. Fifteen patients (23%) used over-the-counter analgesics. Eight patients (12%) used alternative medicine [five women (31%) vs. three men (6%), P=0.02]. Forty-four patients (68%) received immunization against influenza (18 patients <65 years (54%) vs. 25 patients > or =65 years (79%), P=0.03). Half the patients knew that beta-blockers and vasodilators decreased blood pressure, 31 patients receiving diuretics (88%) knew that this drugs help to eliminate liquids, 12 patients (38%) recognized this effect with low dose spironolactone and 23% or less with other drugs. Only 12 patients (42%) treated with acenocoumarol and 13 of those treated with aspirin (32%) recognized the action of these drugs. CONCLUSION: Patients with HF and systolic dysfunction have a poor knowledge about the medication they receive. Polypharmacy, over-the-counter, homeopathic and alternative medicine use is frequent whereas the rate of immunization against influenza is low.

Adult↗

PubMed2004

A clinical case series of switching from antipsychotic polypharmacy to monotherapy with a second-generation agent on patients with chronic schizophrenia.

Second-generation antipsychotic medications have become popular as a treatment for schizophrenia. The authors investigated 25 chronic subjects who had previously been treated with high-dose antipsychotic polypharmacy without amelioration. All patients had a history of having been treated with an antipsychotic polypharmacy regimen of the total daily chlorpromazine equivalent dose exceeding 1000 mg/day for more than 6 weeks. They were subsequently switched to a second-generation antipsychotic monotherapy. Other psychotropic medications were simplified at the same time. For successful patients whose symptoms showed at least minimal improvement, the medical chart was reviewed retrospectively. After completed switching, the patients were followed up for 12 weeks, when final evaluation was made. The Global Assessment of Functioning score improved from 32 to 47. The number of antipsychotic medications and total psychotropic medications were significantly reduced from 3.5 to 1.1 and 6.8 to 2.6, respectively. Also, the antipsychotic dose was significantly minimized from 2203 to 619 mg/day. Eleven of eighteen inpatients were discharged and the other four were better enough to be ready for discharge. By showing successful cases, the authors suggest a possibility of antipsychotic monotherapy with a second-generation agent even for those patients who had been treated with high-dose antipsychotic polypharmacy in vain.

Adult↗

PubMed2002

Use of medications and polypharmacy are increasing among the elderly.

To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.

Age Factors↗

PubMed2001

Polypharmacy among patients admitted to hospital with rheumatic diseases.

AIM: This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. METHODS: The study was performed in departments of rheumatology at nine Norwegian hospitals during five weeks in 1998. Pharmacists recorded all drugs on admittance among patients 18 years or older with rheumatic diseases. RESULTS: Sixty percent of 313 patients had polypharmacy defined as the concurrent use of five or more drugs, and this was most frequent among the older patients. However, they used fewer antirheumatic drugs compared to the younger patients. With regard to the three most common drug groups, older patients used more corticosteroids, and less nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs), compared to the younger. Eighty-four percent of patients on methotrexate used folic acid, but only 52% of the patients who used corticosteroids used calcium supplements. CONCLUSION: Polypharmacy among patients with rheumatic diseases is common, and the present description could be useful for drug-related interventions.

Age Factors↗