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At least 127 records · Page 7Linked to original sources
PubMed2001

The looming polypharmacy crisis in the management of patients with heart failure. Potential solutions.

Physicians may be on the road to a polypharmacy crisis in the development of new drugs for heart failure. They must somehow learn how to tailor the therapy to individual patients, rather than treating all patients with every potentially beneficial drug. This will not be an easy task, but the current model of rational drug development followed by a large megatrial is costly and not likely to be sustained indefinitely.

Forecasting↗
PubMed2001

Polypharmacy of heart failure. Creating a rational pharmacotherapeutic protocol.

In the management of chronic heart failure, polypharmacy is common, necessary, and often overlooked. The increasing costs of care, noncompliance, and frequent adverse drug interactions have led to diminishing benefits by simply adding additional drugs to the already complex regimen. This review outlines a rational pharmacotherapeutic protocol based on establishing overall therapeutic goals and confirming treatment targets, tailoring therapy to individual patients by balancing beneficial and adverse drug effects, and paying particular attention to patient education and other nonpharmacologic support.

Adrenergic beta-Antagonists↗
PubMed2006

Drug therapy of the metabolic syndrome: minimizing the emerging crisis in polypharmacy.

The metabolic syndrome--a collection of factors associated with increased risk for cardiovascular disease and diabetes--is becoming increasingly common, largely as a result of the increase in the prevalence of obesity. Although it is generally agreed that first-line clinical intervention for the metabolic syndrome is lifestyle change, this is insufficient to normalize the risk factors in many patients, and so residual risk could be high enough to justify drug therapy. However, at present there are no approved drugs that can reliably reduce all of the metabolic risk factors over the long term, and so there is growing interest in therapeutic strategies that might target multiple risk factors more effectively, thereby minimizing problems with polypharmacy. This review summarizes current understanding of the nature of the metabolic syndrome, and discusses each of the risk factors of the metabolic syndrome as possible primary drug targets; potential secondary or tertiary targets are also considered.

Atherosclerosis↗
PubMed2001

Collaborating to manage polypharmacy.

DiNCQUMGP (Divisions National Consortium for the Quality Use of Medicines in General Practice) reports on a collaboration between doctors, pharmaceutical companies, government agencies, and medicine users to manage polypharmacy (prescribing multiple medicines to a patient) amongst older people. We have reported the outcomes of our collaboration (improving the Quality Use of Medicines) elsewhere. Here we discuss how we worked together, opened up new opportunities, and learned from one another. The first part of this article outlines a constructive new way of thinking about collaborating, that we argue is fundamentally different from current approaches. The second part describes what we did in the words of those involved.

Cooperative Behavior↗
PubMed2006

Safety of carbamazepine extended-release capsules in bipolar disorder polypharmacy.

BACKGROUND: This analysis is a retrospective chart review evaluating the safety of carbamazepine (CBZ) extended-release capsules (CBZ-ERC) (Shire, Wayne, PA, USA) when used in combination with other agents as part of a polypharmacy regimen in the treatment of patients with bipolar disorder. The safety of CBZ-ERC was determined by comparing the adverse event profiles of patients on monotherapy versus those of patients on polytherapy. METHODS: The medical records of 300 adult patients (aged 18-70) treated in a private practice setting with CBZ (monotherapy or polytherapy) who met the DSM-IV criteria for bipolar disorder were examined. RESULTS: We found that patients taking CBZ-ERC together with other agents (antipsychotics, antiepileptics, selective serotonin reuptake inhibitors and other antidepressants, anxiolytics, lithium, and attention-deficit/hyperactivity disorder medications) were no more likely to report gastrointestinal, nervous system, or cutaneous adverse events than patients on CBZ-ERC monotherapy. CONCLUSIONS: These real-world data suggest that the occurrence of adverse events may not differ significantly between patients on CBZ-ERC monotherapy and those on polytherapy with multiple other agents.

Adolescent↗
PubMed2006

Polypharmacy in oligopopulations: what psychiatric genetics can teach biological psychiatry.

Psychiatric genetics and genomics have made major strides in recent years. Some of that knowledge has yet to permeate in the clinical practice of biological psychiatry. The example of cancer-genetics, biology and clinical treatments may be profitable in terms of accelerating translational integration in psychiatry. We propose that current developments in genetics and genomics point to an Early Low-Dose Rational Polypharmacy in Oligopopulations model for psychiatric pharmacotherapy.

Drug Interactions↗
PubMed1996

Polypharmacy among nursing home geriatric Medicaid recipients.

OBJECTIVE: To determine the factors that influence the number of different drugs prescribed to geriatric Medicaid recipients residing in Louisiana's intermediate care facilities I (ICFs I). DESIGN: Observational and cross-sectional with descriptive and analytic components. PARTICIPANTS: All geriatric Medicaid recipients in Louisiana ICFs I during 1994 (n = 19932). METHODS: Relevant data on sex, age, race, geographic region of a recipient, number of prescribing physicians, number of pharmacies used, and the number of drugs prescribed to a recipient were extracted from the state Medicaid files. Frequencies for the seven study variables were calculated. Regression analysis was used to evaluate the influence of the six predictor variables on the number of drugs prescribed. RESULTS: The study population was 73.63% women, 60.07% 81 years of age and older, 70.65% white, 23.21% African-American, 6.14% other races, and 29.83% from predominantly rural north Louisiana. A total of 44.60% of the residents received prescriptions from one physician, 8.41% of the residents were single pharmacy users, and 45.65% were prescribed more than 10 drugs during the year. The regression model accounted for 20.53% of the total variation in the number of drugs prescribed to a recipient. Race, geographic region, number of prescribing physicians, and number of pharmacies used by a recipient influenced the number of drugs prescribed. CONCLUSIONS: To reduce the number of drugs prescribed and polypharmacy among geriatric Medicaid recipients, Louisiana's ICFs I should minimize the number of physicians and pharmacies used in this population.

Aged↗
PubMed1999

Antipsychotic polypharmacy, Part 1: Therapeutic option or dirty little secret?

Antipsychotic polypharmacy is a surprisingly frequent occurrence that can be both justified and unjustifed, depending on how it is used. To the extent that this phenomenon has been unrecognized and is not being studied, it is a "dirty little secret." To the extent that careful clinicians have uncovered a useful strategy for boosting the effectiveness of available antipsychotic monotherapies, it represents an opportunity to improve the outcomes of patients with psychotic illnesses.

Antipsychotic Agents↗
PubMed2006

Polypharmacy in a 75-year-old patient with schizoaffective disorder.

A 75-year-old white female with schizoaffective disorder was admitted to an inpatient psychiatry unit for uncooperativeness in refusing to take scheduled medications. She complained of anticholinergic adverse effects and had abnormal involuntary movements in the oral/buccal region. The patient had been prescribed six psychotropic medications (i.e., thiothixene, lithium, divalproex sodium, amitriptyline, benztropine, and trazodone effects. The treatment team determined that the patient was noncompliant and experienced the effects of polypharmacy. She had been prescribed two mood stabilizers and suffered from anticholinergic adverse effects and the movement disorder tardive dyskinesia (TD). Four medications were discontinued: thiothixene, amitriptyline, lithium, and benztropine. Quetiapine, a second-generation antipsychotic, was recommended, with a daily titration schedule to reach a target dose of 600 mg per day in divided doses. This agent has less propensity to cause movement disorders compared with first-generation antipsychotics. All medications with additive anticholinergic properties also were discontinued. Lithium was stopped secondary to subtherapeutic levels and potential drug interactions. The pharmacist educated the inpatient team on the additive anticholinergic effects of each medication, reduced the total number of medications prescribed, and assisted in appropriate conversion to quetiapine to reduce TD symptoms.

Aged↗
PubMed1999

[Polypharmacy estimated by means of a population-based prescription database].

The aim was to investigate estimators of polypharmacy (PP) from a population based prescription database. Data were retrieved from Odense Pharmacoepidemiological Database and contained a 10% random sample (n = 26,977) of drug users in 1994. PP was defined as simultaneous treatment with different drugs, and the duration of treatment was calculated from the date of purchase and the number of defined daily doses prescribed. This estimator was compared with an estimator based on the number of drugs purchased during a three month period. On an average day 8.7% were exposed to minor PP (two to four drugs) and 1.2% to major PP (five or more drugs). Purchase of five or more drugs during a three month period predicted episodes of major PP with a positive predictive value of 80%. Epidemiological measures of multiple drug use can be estimated from a prescription database. Conceptually, an estimator based on the number of simultaneously used drugs is preferable, but the number of drugs purchased during a three month period may be a useful alternative estimator.

Databases, Factual↗
PubMed2000

Polypharmacy. Reducing adverse events among the elderly in NJ.

This is the second of a two-part series that focuses on reducing polypharmacy and adverse drug events in the community-dwelling elderly. Part 2 focuses on the medical exception process (MEP), explains information flow relevant to the physician's practice, and provides clinical examples illustrating the potential of computer technology in improving outcomes of care. A combined approach, which employs computer-based technology, values physician judgment, and stresses patient and provider education, is described.

Aged↗
PubMed2000

[Intensified treatment of type 2 diabetes mellitus. Is polypharmacy necessary and justified?].

Newly published randomised controlled trials with pharmacological intervention against hyperglycaemia, hypertension and dyslipidemia have challenged the traditional empiric treatment of type 2-diabetes. This review focuses on the results of these trials as well as randomised trials with pharmacological therapy of microalbuminuria, primary prevention with acetylsalicylic acid and angiotensin converting enzyme (ACE) inhibitors. The overall results from these trials are clinically relevant reductions in the risk of late diabetic complications. Taken together, the new clinical knowledge does not mean that all patients with type 2-diabetes besides relevant changes in lifestyle will benefit from a comprehensive polypharmacy. It means, however, that based upon the individual risk profile the medical professionals have to motivate the patient for an evidence based "therapeutic package" which is likely to improve the longterm outcome.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

Medical therapy in heart failure--is polypharmacy necessary?

The concept of heart failure has undergone several paradigm shifts in the past few decades. Therapeutic targets directed at the heart pump have shifted to circulatory haemodynamics to the current neurohormonal model. Consequently, therapeutic modalities have similarly evolved alongside clinical trials. Successive trials have tested newer drugs in addition to established therapies, resulting in evidence-based treatments necessitating polypharmacy. Optimal heart failure therapy has therefore become increasingly complex. It is only after understanding the precise modes of drug action, as well as the relevance of the design of clinical trials, will physicians hopefully be able to tailor the medical therapy optimally towards the individual patient with heart failure.

Adrenergic beta-Antagonists↗
PubMed2006

Analysis of polypharmacy in older patients in primary care using a multidisciplinary expert panel.

BACKGROUND: Many older patients suffer from chronic diseases for which medicines should be used. Because of the higher number of medicines used and decline in hepatic and renal function, older patients are more prone to problems caused by these medicines. Therefore, it is important to review pharmacotherapy concerning older patients in primary care in a reliable way. AIM: To determine the nature, volume and clinical relevance of prescription-related points of attention in the elderly. DESIGN OF STUDY: Analysis of pharmacotherapy by a multidisciplinary expert panel consisting of GPs, geriatric specialists, clinical pharmacists and community pharmacists. SETTING: Pharmacotherapy of 102 home-dwelling older patients on polypharmacy (> or =75 years, using > or =4 medicines continually) living in the Netherlands. METHOD: The analysis of medication-profiles was based on a two-round consensus method. RESULTS: When performing medication reviews for older people it seemed that for almost all (98%) improvement in pharmacotherapy could be made. For 94% of all patients points of attention could be identified in prescribed medicines, of which 30% was considered to be of direct clinical relevance. In 61% of all patients a medicine could be added to improve pharmacotherapy, 25% of these prescribing omissions were considered to be of direct clinical relevance. CONCLUSION: The regular performance of medication reviews should be part of routine in primary care as it yields significant numbers of prescription-related points of attention. Although they were not all considered to be of direct clinical relevance, all points of attention do ask for a signal to the prescribing physician. This paper is not implying poor practice or poor reviewing practice but documenting the need for performing regular medication reviews.

Aged↗
PubMed1996

The Medication Reduction Project: combating polypharmacy in South Dakota elders through community-based interventions.

The Medication Reduction Project (MED RED) is a community-based program addressing polypharmacy issues in elders. Using educational presentations and one-on-one medication reviews conducted by a pharmacist specializing in geriatrics, MED RED reached over 1,100 older adults in rural and urban southeastern South Dakota communities during 1993. Analysis of the longitudinal data indicate that older adults participating in one-on-one reviews were on fewer medications, had dosage reductions, were more likely to take their medications as directed, and increased their use of non-pharmacological alternatives. These elders also reported feeling better, spent less money per month on medications, and offered indications of improved functioning and increased levels of independence. These findings suggest that education about medication use is a dynamic tool in empowering community-based older adults to be assertive participants in their own health care.

Aged↗
PubMed1997

[Polypharmacy in the elderly with chronic diseases: conflicting interests].

Polypharmacy patients are elderly people with multiple chronic diseases, such as hypertension, heart failure, atrial fibrillation, diabetes mellitus and chronic obstructive pulmonary disease. Many specialists are involved, each of them trying to optimise the function of a particular organ system. The general practitioner has the overall picture and assesses the consequences for the quality of life of the patient. Specialists and pharmacists should consult with the general practitioner, who ought to be in charge of treatment.

Aged↗
PubMed1981

Psychotropic drug use and polypharmacy in a general hospital.

This paper presents the usage of psychotropic drugs by all general inpatients of a Boston teaching and referral hospital on a randomly chosen weekday. Of all surveyed inpatients, 42.8% were receiving at least one psychotropic medication. Sleep medications were the most frequently prescribed class of psychotropic drugs and flurazepam was the most commonly prescribed of all drugs. Phenothiazine and neuroleptics were given to control agitation, pain, or nausea, rather than psychosis. Antidepressants were prescribed without notated justification in the medical record, and if given for depression, were underdosed. Diazepam was the most frequently prescribed antianxiety drug and was the most frequently prescribed psychotropic drug after flurazepam. Psychotropic drug polypharmacy was common, with the average patient receiving seven different drugs. Remedial approaches to this widespread problem are recommended.

Anti-Anxiety Agents↗