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PubMedDate not supplied

Polypharmacy and older people.

Polypharmacy is defined as the practice of prescribing four or more medications to the same person (Department of Health, 2001). This often occurs with older people who have concurrent disease processes, each needing a specific treatment regime (Box 1). Older people receive more prescriptions per head than any other group. The National Service Framework for Older People (DoH, 2001) shows that 5-17 per cent of hospital admissions are caused by adverse reactions to medicines. It also indicates that 6-17 per cent of older patients in hospital experience adverse drug reactions.

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PubMed2005

Antipsychotic polypharmacy or monotherapy?

The concurrent use of more than one drug to treat syndromes and diseases is common in medicine as well as in psychiatry. Despite strong recommendation by experts to employ monotherapy whenever possible, the prevalence of antipsychotic polypharmacy (APP) has greatly increased, particularly since the advent of the Second Generation Antipsychotics (SGA). The literature which consists of three RCTs, several naturalistic cohort studies and numerous case reports does not show convincing evidence of APP efficacy. The best results were seen in studies of augmentation of clozapine response by a second antipsychotic. Studies which examined the side effect burden showed higher rates of anticholinergic and extrapyramidal side effects of APP compared to monotherapy, but these differences tended to disappear when total dosage was controlled for. The relative cost of APP may be higher than monotherapy, but very little data are available. Experts recommend APP in a few special clinical situations: (a) for augmentation when a patient fails to respond to adequate antipsychotic trials, especially with clozapine; (b) in some instances of failed cross-taper of antipsychotics; (c) adding a FGA to a SGA for agitation during acute treatment of psychosis. Indiscriminate condemnation of APP is misdirected, the real culprit being incompetent pharmacotherapy. Improved education and advances in the science of psychopharmacology will lead to more specific antipsychotic therapies and ultimately to less need for APP.

Antipsychotic Agents↗
PubMed1991

Polypharmacy among patients attending an AIDS clinic: utilization of prescribed, unorthodox, and investigational treatments.

The objective of this study was to describe the utilization and characteristics associated with the use of prescribed, over-the-counter, investigational, and unorthodox treatments among AIDS clinic patients. This report is derived from cross-sectional data obtained using structured telephone surveys. Study participants (n = 197) were recruited from the University of California, San Francisco, Medical Center AIDS clinic. One hundred eighty-nine participants (96%) received 1-24 prescription medications during the 3 months prior to interview. Those with an AIDS diagnosis received a relatively greater number of prescription drugs (p = 0.0001); an average of 5.6 prescribed medications were used by AIDS patients versus 4.8 among AIDS-related complex and 2.3 among asymptomatic patients. Thirty-one percent participated in drug trials during the 3 months before interview, including 18% who were in multiple studies. Twenty-nine percent used unorthodox treatments. Seventy-five (40%) received prescription medication from a provider other than their primary provider. A more advanced stage of illness was associated with the use of unorthodox treatments (p = 0.003): users of these treatments had a greater educational attainment than nonusers (p = 0.03) and were significantly less likely to report that their primary provider was aware of all the treatments they used (odds ratio = 2.1, p less than 0.03). We conclude that use of polypharmacy among some AIDS clinic patients is common, could create an increased risk for adverse drug reactions, and may affect clinical drug trials. Despite having decided to obtain care at a university-based clinic, many of the participants of this study also chose to receive unorthodox therapies and care from nonprimary medical providers.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Complex↗
PubMedDate not supplied

Polypharmacy in the elderly: implications for nursing.

Polypharmacy, or the taking of multiple medications, is a common situation for the older individual in today's society. It reflects a change in the focus of medical care for the elderly person from a caring to a curing treatment. Nurses play a major role in identifying people receiving multiple medications and in helping to evaluate their effectiveness. Suggestions for obtaining a complete drug history are presented along with explanations of the role of age-related changes on the effect of those medications on the elderly.

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PubMed1978

A study of the effect of computer feedback on polypharmacy.

Between July 1973 and February 1976, clinicians in the DMH Institutions of a midwestern state received regular, computer generated information about those of their patients who had been prescribed more than 4 psychotropic drugs during the preceding month. The effect of this feedback on prescribing habits was assessed, using information derived from monthly itemized billing record returns. The results showed that, while a highly significant reduction in polypharmacy did take place, it antedated the circulation of the specific feedback, coinciding instead with the discussions between the computer project staff and institution superintendents at the planning stage of the project.

Community Mental Health Services↗
PubMedDate not supplied

Reducing polypharmacy in the nursing home: an activist approach.

BACKGROUND: Nursing home patients generally take many medications and are at risk for drug side effects and interactions. These patients are often frail, have multiple medical problems, and many have severe cognitive deficits. METHODS: Recommendations for reducing polypharmacy in nursing home patients were formulated based upon a review of the medical literature. In many cases, studies of nursing home patients have not been done, and data are extrapolated from other populations. RESULTS AND CONCLUSIONS: The family physician should actively attempt to reduce the nursing home patient's drug list to those drugs that are most likely to improve or maintain function. Anticonvulsants and antiarrhythmics often can be withdrawn, and medications for angina and hypertension might be simplified. Drugs used solely for prevention, such as lipid-lowering agents or anticoagulants, might not have a favorable impact on patients with limited life expectancies. Careful review of the medication list could prevent iatrogenic complications and maximize function in nursing home patients.

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PubMed1996

Perils of polypharmacy: 10 steps to prudent prescribing.

A focused, systematic intervention by the primary care physician can often remedy the problem of polypharmacy in older patients. Such an approach includes medication disclosure, drug identification, side effect recognition, treatment review, and a thoughtful, well-monitored reduction in the numbers and doses of medicines. By developing skillful prescribing habits, the physician can resolve drug side effects, prevent future adverse reactions, reduce pharmacy expenditures, and improve medication compliance. Prudent prescribing is one way to improve quality of life for the older patient.

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PubMed1996

Is there a mechanistic basis for rational polypharmacy?

Established antiepileptic drugs (AEDs) decrease membrane excitability by interacting with neurotransmitter receptors or ion channels. AEDs developed prior to 1980 appear to act on sodium channels. gamma-amino butyric acid type A (GABAA) receptors (GABARs) or calcium channels. Benzodiazepines and barbiturates enhance GABAR-mediated inhibition. Phenytion, carbamazepine and possibly sodium valproate decrease high-frequency repetitive firing of action potentials by enhancing sodium channel inactivation. Ethosuximide and sodium valproate reduce a low threshold (T-type) calcium channel current. The mechanisms of action of the new AEDs are not fully established. Gabapentin binds to a high affinity site on neuronal membranes in a restricted regional distribution of the central nervous system. This binding site may be related to a possible active transport process of gabapentin into neurons; however, this has not been proven and the mechanism of action of gabapentin remains uncertain. Lamotrigine decreases sustained high-frequency repetitive firing of voltage-dependent sodium actin potentials that may result in a preferential decreased release of presynaptic glutamate. Oxcarbazepine's mechanism of action is not known; however, its similarity in structure and clinical efficacy to that of carbamazepine suggests that its mechanism of action may involve inhibition of sustained high-frequency repetitive firing of voltage-dependent sodium action potentials. Vigabatrin irreversibly inhibits GABA transaminase, the enzyme that degrades GABA, thereby producing greater available pools of presynaptic GABA for release in central synapses. Increased activity of GABA at postsynaptic receptors may underlie the clinical efficacy of vigabatrin. The potential mechanistic bases for rational polypharmacy are reviewed.

Animals↗
PubMed1996

Definition of rational antiepileptic polypharmacy.

Rational polypharmacy is in its earliest stages of development and will require substantial additional development to realize its full potential. Indeed, despite the powerful appeal of the concept, clinical proof is not yet available that RP is superior to monotherapy. Important questions need to be addressed: 1. Will RP control seizures more effectively than monotherapy? 2. What data are needed to develop RP for a specific patient? 3. Will RP be cost effective? 4. Can RP be developed which will treat or prevent epilepsy while controlling seizures? Possible approaches to these questions could include: 1. The development of a data base for prospective use to monitor patients being treated at Epilepsy Centers using RP principles. 2. Use the data obtained from the above to construct more specific studies to compare identified combination therapies with monotherapy. 3. Prospectively compare in a placebo controlled, blinded study, the effect of the combination of an anti-ictal medication and a laboratory proven antiepileptic drug for prevention of the development of epilepsy in an at risk population such as head trauma or stroke.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

[Possible ways of managing cardiovascular prevention: polypharmacy, additional payment or application of evidence based medicine?].

The financial balance of the health care system has changed dramatically due to a longer life expectancy and improved treatment options in elderly patients. More than 80% of cardiovascular events are lifestyle related and potentially preventable. Lifestyle modification is therefore the causal approach to decrease cardiovascular events. Improvement of nutrition and activity habits and prevention of cigarette smoking should start in the kindergarten, school and later at the workplace. A co-operation between medical societies and government institutions is necessary to achieve a population wide modification of lifestyle habits to lower the incidence of cardiovascular events in the population. Individual risk stratification is the basis for pharmacological prevention of cardiovascular events. The concept of the polypill has to be tested in controlled randomised studies.

Cardiotonic Agents↗
PubMed1999

Polypharmacy and elderly patients.

Medication therapy in elderly patients is difficult to manage and always has the potential of being hazardous. With the age-related changes that affect the pharmacokinetics and pharmacodynamics of a medication, prescribing medications is further complicated. Similarly, assessment of a medication's efficacy is difficult. The situation becomes more complicated when the patient is taking multiple medications. Nurses in the perioperative area need to be cognizant of a patient's preoperative medication regime and the medications that have been prescribed in the perioperative setting. As medication interactions increase substantially with the number of medications taken, the most pertinent nursing intervention is accurate assessment of the patient. Early recognition of potentially harmful medication effects is critical.

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PubMed2003

Polypharmacy.

Explore the source record for details and available documents.

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PubMed2000

[The quality of sleep associated with polypharmacy].

OBJECTIVE: Study of the association between multiple medication and the quality of sleep. DESIGN: Observational, cross-sectional study through two-stage sampling of 1053 people with a questionnaire and application of the Pittsburgh Sleep Quality Interview (PSQI). SETTING: Primary care. Population covered by health centres in the province of Valladolid. POPULATION: Adults over 18 who attended health centres in Valladolid province. RESULTS: As consumption of multiple drugs rose, there was significant deterioration in the overall quality of sleep and each of the following components: subjective quality, latency of sleep, duration of sleep, extrinsic disturbances and consumption of sleeping draughts. No differences were found for day-time repercussions. When psychiatric drug consumption was excluded from the study (to avoid the risk of bias in psychiatric illnesses), deterioration in the quality of sleep, on adding up the remaining therapeutic groups of drugs, was still found. CONCLUSIONS: The fact of consuming multiple drugs chronically may condition a deterioration in sleep quality, which will stimulate us to combat this symptom with more drugs and so further aggravate the problem. New prospective studies need to be undertaken to find out the reasons.

Adult↗
PubMed1999

Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics.

There are great variations in the way psychotropic drugs are prescribed. Most experts are in favour of psychopharmacological monotherapy, but little is known about the extent to which it is actually practised. A survey of the psychopharmacological medication of all patients under treatment was carried out in three Austrian psychiatric clinics of various types on two separate days. A psychiatric university clinic, the psychiatric department of a general hospital and a regional mental hospital were selected for the survey. It was established that only 8% to 22% of the patients underwent psycho-pharmacological monotherapy and that the patients received 2.2 to 3.3 psychotropics on average. Five to 22% of the patients received five or more psychotropic agents. The results are presented in more detail in relation to the diagnoses of schizophrenia and depression. The rare occurence of monotherapy might be due to unsound treatment regimens in some instances, but much more to a general trend in psychiatry fostering polydrug use.

Adult↗