Neurobiology as a basis for rational polypharmacy. Section overview for rational polypharmacy conference.
Explore the source record for details and available documents.
Animals↗
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.
Polypharmacy: a case report and new protocol for management.
BACKGROUND: Polypharmacy is an important issue in primary care, yet few data are available concerning its prevalence, complications, and management in clinical medicine. The following case illustrates the clinical perils of polypharmacy and serves as a point for critical discussion. METHODS: MEDLINE was searched, using the key word "polypharmacy," from 1994 to the present. A case report of polypharmacy is described, and a novel protocol for the management of polypharmacy is proposed. RESULTS: Polypharmacy can lead to unnecessary expense, wasted time, and embarrassment on the part of the patient and confusion and mismanagement on the part of the physician. The literature reveals controversy surrounding the definition of polypharmacy and reflects the considerable morbidity and expense associated with polypharmacy. Finally, the SAIL protocol shows that physicians need to keep in mind simplicity, adverse effects, indications, and a precise list of all medications to manage appropriately a patient's drug regimen. CONCLUSIONS: Polypharmacy is associated with morbidity and iatrogenic complications. The SAIL protocol can be a useful tool in the management of this entity. More research needs to be done on the prevalence, complications, and management of polypharmacy.
Aged↗
Polypharmacy in general practice: differences between practitioners.
BACKGROUND: Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalization. When the number of concurrently used drugs totals five or more (major polypharmacy), a significant risk may be present. AIM: To analyse the interpractice variation in the prevalence of major polypharmacy among listed patients, and to identify possible predictors of major polypharmacy related to the practice. METHOD: Prescription data were retrieved from the Odense Pharmacoepidemiological Database, and individuals subject to major polypharmacy were identified. The age- and sex-standardized prevalence rate of major polypharmacy was calculated for each practice in the County of Funen in Denmark (n = 173), using the distribution of age and sex of the background population as a reference. The practice characteristics were retrieved from the Regional Health Insurance System. Possible predictors of major polypharmacy related to the general practitioners (GPs) were analysed using backward stepwise linear multiple regression. RESULTS: A six-fold variation between the practices in the prevalence of major polypharmacy was found (16 to 96 per 1000 listed patients; median = 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation. CONCLUSION: A substantial part of the variation in major polypharmacy between practices can be explained by predictors related to practice.
Adult↗
Polypharmacy in an Australian teaching hospital. Preliminary analysis of prevalence, types of drugs and associations.
A computer-based prescription retrieval system was used to study 21,521 prescriptions that had been provided to hospital patients who were receiving predominantly outpatient care. Over a three-month period 338 patients were found to be receiving 10 or more different drugs concomitantly. A further 338 patients were drawn at random from the same outpatient population for comparison. Age was linked significantly to polypharmacy (polypharmacy group: mean age, 63.7 years, SEM = 1.09; comparison group: mean age, 53.8 years, SEM = 1.00, P less than 0.05; chi 2 = 62.8, P less than 0.001). The relative risk of polypharmacy was related linearly to age. Admission to hospital was associated with increased prescribing rates in the polypharmacy sample (P less than 0.05), as was attendance at multiple clinics and multiple attendance at outpatient clinics (P less than 0.05 and P less than 0.05, respectively). Benzodiazepine agents were included in 63.7% of prescriptions in the polypharmacy group and in 37.3% of prescriptions in the comparison group. Non-prescription drugs were noted in 97.2% of prescriptions in the polypharmacy group and 58.0% of prescriptions in the comparison group, representing 34.7% and 27.3% of all items, respectively. In patients of less than 30 years of age agents for allergy/asthma/atopy contributed most to polypharmacy; agents that were associated with renal failure most in patients aged 31-50 years; and agents for cardiovascular disease contributed most in patients aged over 50 years. Our results suggest that a reduction in the use of non-prescription and psychotropic agents, heightened awareness of the dangers of polypharmacy and coordination and integration of over-all care and prescribing habits should reduce polypharmacy materially.
Australia↗
Polypharmacy in psychiatry: three case studies and methods for prevention.
OBJECTIVE: To illustrate problems of overprescribing in the elderly and to make practical suggestions for prevention of polypharmacy. DESIGN: Three cases of polypharmacy in psychiatric patients admitted to the hospital between January and March 1990 are described. Intervention to correct drug-related problems in these patients is described and methods of preventing polypharmacy are discussed. SETTING: Inpatient psychiatry service in a tertiary-care center. PATIENTS: Elderly psychiatry patients (n = 3) taking an excessive number of medications. This polypharmacy was believed to contribute to decreased cognitive and/or physical function. INTERVENTIONS: Medication regimens were reviewed by the physician and pharmacist. Those considered unnecessary or believed to be adversely affecting the patient were discontinued. RESULTS: All patients were discharged on a reduced number of medications, with improvement in cognitive and/or physical function. CONCLUSIONS: Polypharmacy contributes to an increased incidence of adverse reactions in the elderly. Implementation of practical methods for reducing polypharmacy can lead to a reduction in the number of drug-related adverse effects and improved care of the elderly patient.
Aged↗
Overcoming problems with polypharmacy and drug misuse in the elderly.
Polypharmacy, the inappropriate use of multiple drug regimens, has a significant impact on the health of elderly individuals. Drug use increases with age, but suitability of therapy is sometimes difficult to define. In ambulatory and hospital care, there is some documentation of poor prescribing practices by physicians and drug misuse by patients. Sound data suggest that polypharmacy and drug misuse are highly prevalent in long-term care facilities. Psychotherapeutic agents are the most commonly misused drugs by physicians in this setting. Polypharmacy is associated with factors such as the number and severity of illnesses, hospitalization, number of physicians seen, number of pharmacies used, and possibly increased patient age. Methods to prevent polypharmacy and drug misuse have not been well studied. There is a need for intensive research to define effective methods to strengthen prescribing practice of physicians for elderly patients, to promote cooperation among health care personnel in ensuring optimal drug use by patients, and to enhance the role of patients as responsible partners in drug therapy. The authors are confident, however, that drug misuse and polypharmacy can be reduced in older persons by the use of current knowledge of risk factors associated with polypharmacy and by improved communication between the physician and patient.
Aged↗
Decreasing polypharmacy in clients most at risk.
Approximately one third of all drugs prescribed in the United States are considered unnecessary. Polypharmacy, the unnecessary, excessive use of prescription and over-the-counter medications, increases clients' risk for adverse drug reactions and drug-drug interactions. Reducing the incidence of polypharmacy is a health protection goal of Healthy People 2000. Older clients, particularly older women living independently in the community, are at highest risk for polypharmacy caused by age-related changes in pharmacokinetics and pharmacodynamics, the presence of comorbidities requiring pharmacologic management, and high rates of unintentional noncompliance with their therapeutic regimen. Health providers may contribute to polypharmacy directly by excessive or inappropriate prescribing practices or indirectly through their inability to resist client's demands for pharmacologic interventions. Strategies to prevent and detect polypharmacy are suggested to reduce its incidence and the severity of its consequences.
Aged↗
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↗
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↗
[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↗
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↗
Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients.
Urinary incontinence, delirium and polypharmacy are common, challenging problems encountered in elderly patients. Review of the literature shows that these conditions are interrelated. For example, polypharmacy can lead to delirium, which, in turn, can lead to urinary incontinence. The drugs prescribed for urinary incontinence can precipitate delirium or contribute to polypharmacy. The underlying causes for these problems in elderly patients are frequently complex, and management in turn must often be multifactorial. The occurrence of these problems should lead to careful evaluation followed by thoughtful, responsive treatment. Brief updates are given with recommendations for management directed at primary care physicians.
Adrenergic alpha-Agonists↗
Reduction of polypharmacy in epileptic patients.
An attempt was made to reduce polypharmacy in 90 epileptic patients. All patients received their original drug regimen for at least six months and were followed up for a minimum of 16 months after reduction of polypharmacy. In 72 patients (80%), the average number of drugs administered was reduced from 2.75 to 1.49. In 39 of these (54%), a reduction was made to single drug therapy. Either no change or an improvement in seizure control was observed, and side effects decreased in many patients. In 18 patients (20%), medications could not be withdrawn. In nine of these, another drug was required for seizure control. In the remaining nine, more frequent seizures necessitated a return to the previous regimen. The critical variable predicting unsuccessful reduction of polypharmacy was the presence of multiple concurrent seizure types.
Adult↗
Reducing polypharmacy in the elderly. A controlled trial of physician feedback.
A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.
Aged↗
An improvement in cognitive function following polypharmacy reduction in a group of epileptic patients.
18 epileptic patients on polypharmacy were assessed, using a battery of psychometric tests including the Wechsler Adult Intelligence Scale, Benton Visual Retention Test and Alertness and Concentration tests. The same patients were reassessed one year later following a trial to reduce their polypharmacy. The results for 12 patients whose treatment was reduced to monotherapy were statistically analysed, using the Wilcoxon Matched Pairs Test. Significant changes were found on a number of test scores which included Full Scale WAIS I.Q., W.A.I.S. Performance I.Q., Digit Symbol, Block Design and Object Assembly, Benton Visual Retention Test Error Score and Concentration Test Score. The other tests showed no improvement over baseline. The results point to the improvement in some areas of cognitive function which follows a reduction in polypharmacy to monotherapy.
Adult↗
Reduction in polypharmacy for epilepsy.
A two-year prospective study of 40 adult outpatients with chronic epilepsy was carried out in which blood drug concentrations were monitored, and anticonvulsant polypharmacy was reduced to treatment with a single drug in 29 patients (72%). In the year after the reduction of treatment the control of seizures was improved in 16 patients (55%), unchanged in eight(28%), and worse in five (17%). Mental function was improved in 16 (55%). The main reason for failure to reduce to or maintain treatment with a single drug was exacerbation of seizures during the difficult withdrawal period, especially in patients with frequent seizures, taking several drugs, or with additional neuropsychological handicaps. It is more difficult to reduce polypharmacy than to avoid it in the first place. Polypharmacy may sometimes aggravate control of seizures.
Adolescent↗
Polypharmacy in geriatric patients.
Although research-based information concerning geriatric polypharmacy is lacking, available data suggest possible causes, health risks, and areas for intervention. Nursing home residents are more likely to be recipients of unnecessary and excessive drugs than community-dwelling elderly. Polypharmacy can lead to increased adverse drug reactions, drug interactions, and medication errors. In the future, there will be single drug therapy for conditions now requiring multiple drugs, but improved diagnosis of disease could lead to persons receiving additional, appropriate drugs for these health problems. Informed patients collaborating with knowledgeable prescribers and those dispensing and administering their medications may be able to reduce the number of drugs they are taking. More research is needed to identify methods that promote safe self-medication behavior and better drug use in nursing homes. Health risks associated with polypharmacy and the escalating costs of medications require that nurse participation in ensuring that the elderly receive only necessary and effective drug treatment.
Aged↗
Polypharmacy in bipolar I disorder.
There are currently three mood stabilizers available for the maintenance treatment of patients with bipolar I disorder: lithium, valproate, and carbamazepine. Unfortunately, monotherapy with each of these conventional agents often fails. To improve outcome, clinicians utilize polypharmacy. Although the efficacy of this practice is largely unknown, because of the lack of controlled studies, data from the United States and Europe indicate polypharmacy is the rule rather than the exception. The few controlled trials that have been conducted indicate that (1) the specific combination of lithium plus imipramine provides no advantage over lithium monotherapy (notwithstanding the inadequacy of lithium monotherapy); (2) the specific combination of lithium and the depot neuroleptic flupenthixol provides no advantage over lithium monotherapy; and (3) the combination of lithium plus carbamazepine may be as effective as lithium plus haloperidol for acute and continuation treatment. Most of the literature on polypharmacy consists of case reports, retrospective chart reviews, and open-label prospective studies, and describes the use of numerous combinations of medications, including lithium plus valproate, lithium plus carbamazepine, and valproate plus carbamazepine. Preliminary findings suggest these combinations may be effective, and that clozapine and high-dose levothyroxine may each be useful as well when combined with other drugs. Further research is necessary to formally evaluate whether these drug combinations are more effective than monotherapy. Until such studies are completed, certain general principles regarding side effects, pharmacodynamics, and pharmacokinetics should be kept in mind when prescribing two or more medications concurrently.
Bipolar Disorder↗