PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Polypharmacy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed2006

Does antipsychotic polypharmacy increase the risk for metabolic syndrome?

OBJECTIVE: To determine whether the coprescribing of two or more antipsychotics, a relatively frequent practice with little data to support its safety and efficacy, is associated with an increased prevalence of metabolic syndrome. METHODS: 364 newly admitted adults treated with second-generation antipsychotics underwent assessments evaluating antipsychotic polytherapy, and of the presence of metabolic syndrome and triglycerides/high-density lipoprotein cholesterol ratio>3.5 (TG/HDL), a sensitive marker of insulin resistance. The correlates of antipsychotic polytherapy and associations with metabolic syndrome and TG/HDL were determined by univariate comparisons and multiple logistic regression analyses. RESULTS: Antipsychotic polytherapy was present in 70 patients (19.2%) and was significantly more likely in patients with schizophrenia and those treated with clozapine, quetiapine or ziprasidone (p<0.0001). Compared with antipsychotic monotherapy, polytherapy was associated with elevated rates of metabolic syndrome (50.0% vs. 34.3%, p=0.015) and TG/HDL (50.7% vs. 35.0%, p=0.016). However, in logistic regression analyses, metabolic syndrome was significantly associated with higher body mass index (BMI), older age, a diagnosis of bipolar disorder or schizophrenia, and cotreatment with a first-generation antipsychotic (r(2): 0.25, p<0.0001). The TG/HDL marker of insulin resistance was associated with higher BMI, male sex, Caucasian race and absence of aripiprazole treatment (r(2): 0.14, p<0.0001). Antipsychotic polypharmacy dropped out of both multivariate models. CONCLUSIONS: Compared with patients receiving antipsychotic monotherapy, patients on antipsychotic polytherapy have higher rates of metabolic syndrome and lipid markers of insulin resistance. However, antipsychotic polytherapy is not independently associated with the prevalence of these abnormalities, which are related to known demographic, clinical and anthropometric risk factors.

Adult↗
PubMed1997

Effects of comorbidity and polypharmacy on the clinical usefulness of sertraline in elderly depressed patients: an open multicentre study.

Antidepressant therapy in the elderly age group is frequently complicated by medical comorbidity, polypharmacy and increased sensitivity to drug effects. A nonblind, noncomparative, observational, multicentre study over 8 weeks was conducted to assess the effectiveness and tolerability of sertraline (50-200 mg/day) in 1437 elderly depressed outpatients with a mean (S.D.) age of 68 (6.3) years (range 60-92) in routine clinical practise. Depressive symptoms were monitored using the Montgomery Asberg Depression Rating Scale (MADRS) at baseline and at weeks 2, 4, 6 and 8. The mean dose of sertraline at the final visit was 85.2 mg/day (48% of patients were given the initial dose throughout the study). At the end of the study, mean percentage change of MADRS score from baseline was 61% (P < 0.001). A > or = 50% decrease in MADRS score was obtained in 70% of patients. Sertraline was well tolerated. Side effects occurred in 23% of patients, although only 5.1% withdrew because of adverse events. There were no significant differences in the antidepressant effectiveness or occurrence of side effects when patients with and without concomitant pathologic conditions or with and without concurrent medications were compared. These findings indicate the absence of clinically important drug interaction and confirm the effectiveness and safety of sertraline in routine clinical practise for treating elderly depressed outpatients.

1-Naphthylamine↗
PubMed2006

Corneal deposits and topical ofloxacin--the effect of polypharmacy in the management of microbial keratitis.

PURPOSE: To report six cases of corneal deposits after administration of topical ofloxacin in the treatment of bacterial keratitis. METHOD/RESULT: Six cases of microbial keratitis treated with multiple topical medications, including topical ofloxacin, resulted in corneal precipitates and poor wound healing. In five cases, the precipitates resolved with discontinuation of ofloxacin treatment. However, in one patient, some residual deposits persisted following discontinuation of ofloxacin. The cornea epithelialised, but deposits were identified subepithelially. DISCUSSION: Fluoroquinolone antibiotic drops have been extensively used in bacterial keratitis because of their ease of availability, broad spectrum of activity, and lack of toxicity. While corneal precipitates have been reported with cases of topical ciprofloxacin and norfloxacin, little has been documented on corneal deposits and topical ofloxacin in the treatment of bacterial keratitis. The predisposing factors resulting in corneal deposits and the role of polypharmacy are important features that may impair epithelialisation. Clinical management should be aimed at reducing the toxic environment and promoting ocular surface stability.

Administration, Topical↗
PubMed2001

Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department.

STUDY OBJECTIVES: We sought to document the degree of polypharmacy, the frequency of adverse drug-related events (ADREs) leading to emergency department presentation that were recognized by emergency physicians, and the frequency of potential adverse drug interactions (PADIs) in medication regimens of elderly patients in the ED. METHODS: We conducted a retrospective chart review on 300 randomly selected ED visits made by patients 65 years of age and older between January 1 and December 31, 1998. ADREs were defined according to a standardized algorithm. PADIs were identified by using the drug interaction database PharmVigilance. RESULTS: After excluding 17 patient visits with inadequate documentation, 283 were left for review. Of these, 257 (90.8%) patients were taking 1 or more medications (prescribed or over the counter). The number of medications consumed ranged from 0 to 17 and averaged 4.2 (SD+/-3.1) drugs per patient. ADREs accounted for 10.6% of all ED visits in our patient group. The most frequently implicated classes of medications were nonsteroidal anti-inflammatory drugs, antibiotics, anticoagulants, diuretics, hypoglycemics, beta-blockers, calcium-channel blockers, and chemotherapeutic agents. Thirty-one percent of all patients in our group had at least 1 PADI in their medication list. Among patients who presented because of an ADRE, 50% had at least 1 PADI in their medication list that was unrelated to the ADRE with which they presented. CONCLUSION: ADREs are an important cause of ED presentation in the elderly. PADIs are found in a significant proportion of medication lists. Emergency physicians must be vigilant in monitoring elderly patients for medication-related problems.

Aged↗
PubMed1998

Lithium plus valproate as maintenance polypharmacy for patients with bipolar I disorder: a review.

Standard pharmacotherapy for the maintenance treatment of patients with bipolar I disorder consists of lithium, valproate, or carbamazepine. However, many patients fail to respond to monotherapy with any of these agents, and as a result, psychiatrists often resort to polypharmacy. Findings from some open-label trials and retrospective chart reviews suggest this approach may be useful, but in the few controlled trials that have been conducted, the results have been negative. One drug combination that warrants further study as maintenance therapy is lithium plus valproate. Each is approved by the U.S. Food and Drug Administration for treatment of acute mania, and lithium has demonstrated efficacy for maintenance treatment as well. Some preliminary evidence suggests that the combination can be effective for patients who do not respond to monotherapy, and it seems to be no more dangerous than monotherapy. Concomitant administration of lithium plus valproate does not significantly alter lithium pharmacokinetics, and statistically significant changes that arise in valproate pharmacokinetics are not clinically significant. Although it is not known whether the drugs interact to augment response, many of their effects in the central nervous system do differ, and there is no indication of pharmacodynamic interactions that oppose each other. Finally, some evidence suggests that lithium and valproate may differ with regard to clinical variables that predict response to treatment.

Antidepressive Agents↗
PubMed1998

Combination Drug Therapy in Patients with Heart Failure: Tenets of Rational Polypharmacy.

Combining drugs to treat patients with heart disease is common. It is important to assess this practice with respect to sound principles of therapeutics and review what has become a complicated and challenging practice, combining drugs to treat heart failure. The purpose of this review is to consider the philosophy of polypharmacy in heart failure and formulate specific recommendations regarding the creation of a rational pharmacologic approach to these patients.

Journal Article↗
PubMed1990

Antiepileptic polypharmacy, psychosocial behaviour and locus of control orientation among mentally handicapped adults living in the community.

The relationship between psychosocial behaviour, antiepileptic regime (polytherapy compared to monotherapy) and seizure frequency was explored in a sample of mentally handicapped adults living in the community. Locus of control perceptions were studied in relation to seizure frequency. Antiepileptic polypharmacy was found to have a detrimental effect upon psychosocial functioning independent of seizure frequency, which is itself a risk factor for social disturbance; and external perceptions of locus of control predominated. The distribution of drugs used is reported. These results are discussed in the context of implications for future research in the areas of coping, mental handicap and antiepileptic pharmacotherapy.

Adult↗
PubMed1993

Polypharmacy in a headache centre population.

In this paper we report the prevalence of self-medication and polypharmacy in our patient population at the John R. Graham Headache Centre at the Faulkner Hospital, Boston. One hundred fifty patients were interviewed when they called the Headache Centre and spoke to a triage nurse. A significantly higher number of women than men called in for triage counselling. Sixty-nine percent of the patients reported taking non-Headache Centre medications, either prescribed or over the counter (OTC); 39% of the patients took pain medications. Thirty-one different medications were named by patients for a mix of diagnoses.

Adult↗
PubMed2003

Lidocaine patch 5% with systemic analgesics such as gabapentin: a rational polypharmacy approach for the treatment of chronic pain.

OBJECTIVE: To assess the effectiveness and safety of the lidocaine patch 5%, a targeted peripheral analgesic, in the treatment of postherpetic neuralgia, painful diabetic neuropathy, and low back pain patients with incomplete responses to their current analgesic treatment regimen containing gabapentin. DESIGN: This was a 2-week, open-label, nonrandomized, multicenter pilot trial in the clinical setting. Patients with postherpetic neuralgia, painful diabetic neuropathy, or low back pain with partial responses (average daily pain intensity >4/10) to their current analgesic treatment regimen were included. Treatment consisted of daily application of up to four lidocaine patches to areas of maximal peripheral pain. Effectiveness was evaluated using the Brief Pain Inventory (BPI). Safety was assessed by adverse events, physical and neurologic examinations, vital signs, and clinical laboratory tests. RESULTS: Significant improvements in BPI measures of pain intensity and pain relief were reported for all groups of patients after 2 weeks of lidocaine patch 5% treatment. Significant improvements in BPI measures of pain interference with general activity, mood, walking ability, normal work, relationships with others, sleep, and enjoyment of life were noted. The lidocaine patch 5% was found to be safe and well tolerated. CONCLUSIONS: Results of this study highlight the potential advantages achieved with rational polypharmacy using a targeted peripheral analgesic, the lidocaine patch 5%, with centrally acting agents such as the anticonvulsant gabapentin. Controlled trials are warranted to further define the impact of such combination therapy.

Acetates↗
PubMed1981

Role of carbamazepine in reducing polypharmacy in epilepsy.

Carbamazepine was given to 152 patients who were receiving multiple drug therapy for uncontrolled seizures. The age range was 3 to 57 years. The mean average duration of epilepsy and carbamazepine therapy was 7.6 years and 19 months respectively. The conclusions are: (i) Carbamazepine is effective in reducing the multiple drug therapy while still maintaining better control of epilepsy. (ii) Carbamazepine by reducing polypharmacy in epilepsy and probably by the relative lack of sedative action is effective in improving school or work performances. (iii) Carbamazepine is a safe antiepileptic drug.

Acetazolamide↗
PubMed1992

Rationalizing neuroleptic polypharmacy in chronic schizophrenics: effects of changing to a single depot preparation.

This study investigated the effects of transferring patients on combined depot and oral neuroleptics to a single depot preparation; a secondary objective was to assess the effects of transferring patients from one depot neuroleptic to another. It was found that, whereas transferring from one depot preparation (flupenthixol) to another (fluphenazine) had no clear disadvantage for the patients, changing over from a combined oral and depot (fluphenazine) regimen to equivalent doses of depot alone resulted in an unacceptably high rate of relapse. The reasons for this may relate to either the unique pharmacokinetics of these drugs or subtle qualitative differences between them. It is suggested that caution is necessary whenever attempts are made to rationalize polypharmacy in schizophrenic patients.

Administration, Oral↗
PubMed1977

Unnecessary polypharmacy for epilepsy.

A retrospective survey of 50 adult epileptic outpatients who were taking two anticonvulsants drugs showed that seizure control had improved in the six months after the introduction of the second drug in only 36%. When blood concentrations of the two anticonvulsants were subsequently measured improvement in seizure control was found to be significantly related to the presence of optimum blood concentrations of at least one drug. Much unnecessary polypharmacy in the treatment of epilepsy could be avoided by ensuring an optimum blood concentration of one drug before considering the addition of a second.

Adolescent↗
PubMed1992

Acute confusional states in older adults and the role of polypharmacy.

Cognitive impairment resulting from drug therapy in older persons has been well documented for numerous classes of drugs. Unfortunately, the problem of ACS caused by polypharmacy is rarely reported in the medical literature, although we believe that it occurs frequently. Health professionals need more education concerning the risks of drug therapy in older persons and methods of reducing the use of multiple drug therapy. Finally, more research is needed to identify patient and drug factors that lead to drug-induced ACS and cognitive decline in the elderly.

Aged↗
PubMed1988

Polypharmacy: its cost burden and barrier to medical care in a drug-oriented health care system.

In order to determine the economic and therapeutic implications of the prescriber habit in a drug-oriented health care system, data were collected on the provisional diagnosis, prescribed drugs, and their cost and procurement pattern among 1450 pediatric outpatients in a Nigerian University Teaching Hospital. It was found that on average, about five drugs were prescribed for each patient, and there was a tendency to prescribe more expensive and sometimes unnecessary drugs. The more the number or higher the cost of drugs prescribed, the less patients procured them. It is therefore recommended that health care authorities and physicians in similar settings should review their drug policies and prescribing habits in order to discourage polypharmacy and the high cost of chemotherapy, with their attendant barrier to medical care.

Child↗
PubMed1999

Polypharmacy. Reducing adverse events among the elderly in NJ. Part 1.

This is the first of a two-part series that focuses on reducing polypharmacy and adverse drug events in the community-dwelling elderly. Part 1 provides a rationale for the design of public health interventions to reduce this problem and explores technology development. The components of an integrated system linking computer-based technology, pharmacists, and physicians are outlined.

Aged↗
PubMed2000

Monotherapy and polypharmacy.

The availability of many new antiepileptic drugs (AEDs) with novel mechanisms of action has made polypharmacy, using combinations of AEDs with differing mechanisms, a viable alternative. The concept of monotherapy in epilepsy is relatively new, having attained widespread use only during the past few decades, and replacing irrational use of combinations of AEDs. In intractable epilepsy, however, monotherapy is often unsuccessful in achieving complete control, and skilled use of AEDs with differing mechanisms may provide better results. Monotherapy remains the treatment method of choice for new-onset epilepsy, but if control is not achieved, rational combinations should be considered. Most critical to successful treatment of epilepsy is the correct identification of the epileptic syndrome.

Anticonvulsants↗
PubMed1976

Samuel Hyde lecture. Polypharmacy in rheumatoid arthritis--help or hindrance?

The use of multiple drugs in treating rheumatoid arthritis is based on the assumption that their effects are additive. Sometimes the results are unexpected or the added drug may confer no additional benefit to the patient whilst leaving him more liable to undesirable side-effects. Some form of polypharmacy may be necessitated by the different pharmacological properties of our drugs. Certain drugs have been judged on their steroid-sparing effects allowing lower doses to be used and thereby reducing the toxicity of corticosteroids. It is likely that some potential areas of danger from interacting drugs have been over-emphasized, being based on speculative rather than real data or purely on animal experiments using non-clinical doses. The patient with active RA with a low serum albumin would be unusually susceptible to changes induced by combinations of strongly bound anti-inflammatory drugs. He would also be highly susceptible to side-effects, as has been shown with prednisone. Side-effects here are doubled when the patients serum albumin is below 2.5g/100ml(lewis et al.1971). I believe we should continue to ask ourselves whether by subtracting one or more drugs from the patients cocktail we may not produce a most welcome benefit for both patient and doctor and, I suppose we could even add, the hard-pressed tax payer.

Adrenal Cortex Hormones↗