Polypharmacy and the risk of drug-drug interactions and potentially inappropriate medications in hospital psychiatry.
drug interactions
hospitals
pharmacoepidemiology
polypharmacy
psychiatry
psychotropic drugs
Journal
Pharmacoepidemiology and drug safety
ISSN: 1099-1557
Titre abrégé: Pharmacoepidemiol Drug Saf
Pays: England
ID NLM: 9208369
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
revised:
27
05
2021
received:
23
01
2021
accepted:
09
06
2021
pubmed:
20
6
2021
medline:
15
12
2021
entrez:
19
6
2021
Statut:
ppublish
Résumé
The aim of this study was to analyze the epidemiology of polypharmacy in hospital psychiatry. Another aim was to investigate predictors of the number of drugs taken and the associated risks of drug-drug interactions and potentially inappropriate medications in the elderly. Daily prescription data were obtained from a pharmacovigilance project sponsored by the Innovations Funds of the German Federal Joint Committee. The study included 47 071 inpatient hospital cases from eight different study centers. The mean number of different drugs during the entire stay was 6.1 (psychotropic drugs = 2.7; others = 3.4). The mean number of drugs per day was 3.8 (psychotropic drugs = 1.6; others = 2.2). One third of cases received at least five different drugs per day on average during their hospital stay (polypharmacy). Fifty-one percent of patients received more than one psychotropic drug simultaneously. Hospital cases with polypharmacy were 18 years older (p < 0.001), more likely to be female (52% vs. 40%, p < 0.001) and had more comorbidities (5 vs. 2, p < 0.001) than hospital cases without polypharmacy. The risks of drug-drug interactions (OR = 3.7; 95% CI = 3.5-3.9) and potentially inappropriate medication use in the elderly (OR = 2.2; CI = 1.9-2.5) substantially increased in patients that received polypharmacy. Polypharmacy is frequent in clinical care. The number of used drugs is a proven risk factor of adverse drug reactions due to drug-drug interactions and potentially inappropriate medication use in the elderly. The potential interactions and the specific pharmacokinetics and -dynamics of older patients should always be considered when multiple drugs are used.
Substances chimiques
Pharmaceutical Preparations
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1258-1268Informations de copyright
© 2021 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
Références
Taylor M, Perera U. NICE CG178 psychosis and schizophrenia in adults: treatment and management-an evidence-based guideline? Br J Psychiatry. 2015;206(5):357-359. https://doi.org/10.1192/bjp.bp.114.155945
Bolea-Alamañac B, Nutt DJ, Adamou M, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(3):179-203. https://doi.org/10.1177/0269881113519509
Goldberg SG, Wagner K. American Psychological Association practice guidelines for psychopharmacology: ethical practice considerations for psychologists involving psychotropic use with children and adolescents. J Clin Psychol. 2019;75(3):344-363. https://doi.org/10.1002/jclp.22705
Goodwin GM, Young AH. The British Association for Psychopharmacology guidelines for treatment of bipolar disorder: a summary. J Psychopharmacol. 2003;17(4):3-6.
Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19(6):567-596. https://doi.org/10.1177/0269881105059253
Hiemke C, Shams M. Phenotyping and genotyping of drug metabolism to guide pharmacotherapy in psychiatry. Curr Drug Deliv. 2013;10(1):46-53. https://doi.org/10.2174/1567201811310010008
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2
Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-995. https://doi.org/10.1016/j.jclinepi.2012.02.018
WHO. Medication Safety in Polypharmacy. World Health Organization; 2019.
Molokhia M, Majeed A. Current and future perspectives on the management of polypharmacy. BMC Fam Pract. 2017;18(1):70. https://doi.org/10.1186/s12875-017-0642-0
Scheidt-Nave C, Richter S, Fuchs J, Kuhlmey A. Herausforderungen an die Gesundheitsforschung für eine alternde Gesellschaft am Beispiel “Multimorbidität”. Bundesgesundheitsbl. 2010;53(5):441-450. https://doi.org/10.1007/s00103-010-1052-9
Preskorn SH, Lacey RL. Polypharmacy: When is it rational? J Psychiatr Pract. 2007;13(2):97-105. https://doi.org/10.1097/01.pra.0000265766.25495.3b
Cadogan CA, Ryan C, Hughes CM. Appropriate polypharmacy and medicine safety: when many is not too many. Drug Saf. 2016;39(2):109-116. https://doi.org/10.1007/s40264-015-0378-5
Duerden M, Avery T, Payne R. Polypharmacy and Medicines Optimisation-Making it Safe and Sound. London: The King's Fund; 2013.
Moßhammer D, Haumann H, Mörike K, Joos S. Polypharmacy-an upward trend with unpredictable effects. Dtsch Arztebl Int. 2016;113:627-633. https://doi.org/10.3238/arztebl.2016.0627
Gill SS, Mamdani M, Naglie G, et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med. 2005;165(7):808. https://doi.org/10.1001/archinte.165.7.808
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716. https://doi.org/10.1001/jama.294.6.716
Dumbreck S, Flynn A, Nairn M, et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UKnational clinical guidelines. BMJ. 2015;350:h949. https://doi.org/10.1136/bmj.h949
Kratz T, Diefenbacher A. Psychopharmacological treatment in older people. Dtsch Arztebl Int. 2019;116:508-518. https://doi.org/10.3238/arztebl.2019.0508
Leone R, Magro L, Moretti U, et al. Identifying adverse drug reactions associated with drug-drug interactions: data Mining of a Spontaneous Reporting Database in Italy. Drug Saf. 2010;33(8):667-675. https://doi.org/10.2165/11534400-000000000-00000
Steinman MA, Miao Y, Boscardin WJ, Komaiko KDR, Schwartz JB. Prescribing quality in older veterans: a multifocal approach. J Gen Intern Med. 2014;29(10):1379-1386. https://doi.org/10.1007/s11606-014-2924-8
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-551. https://doi.org/10.3238/arztebl.2010.0543
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716. https://doi.org/10.1001/archinte.163.22.2716
Hefner G, Hahn M, Hiemke C, et al. Pharmacodynamic drug-drug interactions of QT-prolonging drugs in hospitalized psychiatric patients. J Neural Transm. 2021;128:243-252. https://doi.org/10.1007/s00702-020-02291-y
Zanger UM, Schwab M. Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Therapeut. 2013;138(1):103-141. https://doi.org/10.1016/j.pharmthera.2012.12.007
Hefner G, Wolff J, Hahn M, et al. Prevalence and sort of pharmacokinetic drug-drug interactions in hospitalized psychiatric patients. J Neural Transm. 2020;127:1185-1198. https://doi.org/10.1007/s00702-020-02214-x
National Institute of Diabetes and Digestive and Kidney Diseases. Anticholinergic Agents. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93(9):457-462. https://doi.org/10.1177/014107680009300903
Toto S, Hefner G, Hahn M, et al. Current use of anticholinergic medications in a large naturalistic sample of psychiatric patients. J Neural Transm. 2021;128:263-272. https://doi.org/10.1007/s00702-020-02298-5
Möller H-J, Benkert O, Gastpar M, Laux G, Antidepressiva RE. In: Möller H-J, Benkert O, Gastpar M, Laux G, Rüther E, eds. Behandlungsleitlinie Psychopharmakotherapie. Heidelberg: Steinkopff; 2003:1-32.
Khan Q, Ismail M, Haider I, Ali Z. Prevalence of the risk factors for QT prolongation and associated drug-drug interactions in a cohort of medical inpatients. J Formos Med Assoc. 2019;118(1):109-115. https://doi.org/10.1016/j.jfma.2018.01.016
Wenzel-Seifert K, Wittmann M, Haen E. QTc prolongation by psychotropic drugs and the risk of torsade de pointes. Dtsch Arztebl Int. 2011;108(41):687-693. https://doi.org/10.3238/arztebl.2011.0687
Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62(10):1916-1922. https://doi.org/10.1111/jgs.13054
Pasquier M, Pantet O, Hugli O, et al. Prevalence and determinants of QT interval prolongation in medical inpatients: QT interval prolongation. Intern Med J. 2012;42(8):933-940. https://doi.org/10.1111/j.1445-5994.2011.02447.x
Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications: age-related changes in pharmacokinetics and pharmacodynamics. Br J Clin Pharmacol. 2003;57(1):6-14. https://doi.org/10.1046/j.1365-2125.2003.02007.x
Hefner G, Hahn M, Toto S, et al. Potentially inappropriate medication in older psychiatric patients. Eur J Clin Pharmacol. 2021;77:331-339. https://doi.org/10.1007/s00228-020-03012-w
Motter FR, Fritzen JS, Hilmer SN, Paniz ÉV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol. 2018;74(6):679-700. https://doi.org/10.1007/s00228-018-2446-0
Wolff J, Gary A, Jung D, et al. Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach. BMC Med Inform Decis Mak. 2020;20(1):21. https://doi.org/10.1186/s12911-020-1042-2
Wolff J, Hefner G, Normann C, et al. Predicting the risk of drug-drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study. BMJ Open. 2021;11(4):e045276. https://doi.org/10.1136/bmjopen-2020-045276
Wolff J, Reißner P, Hefner G, et al. Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders. Preprint: medRxiv 2021033121254518; 2021.
Hiemke C, Bergemann N, Clement H, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry. 2018;51(1/2):9-62. https://doi.org/10.1055/s-0043-116492
Grözinger M, Dragicevic A, Hiemke C, Shams M, Müller MJ, Härtter S. Melperone is an inhibitor of the CYP2D6 catalyzed O-demethylation of venlafaxine. Pharmacopsychiatry. 2003;36(1):3-6. https://doi.org/10.1055/s-2003-38084
Mannheimer B, von Bahr C, Pettersson H, Eliasson E. Impact of multiple inhibitors or substrates of cytochrome P450 2D6 on plasma risperidone levels in patients on polypharmacy. Ther Drug Monit. 2008;30(5):565-569. https://doi.org/10.1097/FTD.0b013e31818679c9
Wójcikowski J, Pichard-Garcia L, Maurel P, Daniel WA. Perazine as a potent inhibitor of human CYP1A2 but not CYP3A4. Pol J Pharmacol. 2002;54(4):407-410.
Schaller G, Jacobi A, Rotter A, Kornhuber J, Hillemacher T. Perazine elevates clozapine serum levels by inhibiting hepatic metabolism. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(5):908-909. https://doi.org/10.1016/j.pnpbp.2009.04.006
Fischer M, Unterecker S, Deckert J, Pfuhlmann B. Elevated clozapine serum levels in combination with perazine. Psychopharmacology (Berl). 2013;226(3):623-625. https://doi.org/10.1007/s00213-013-3007-y
Hiemke CC, Eckermann G. Kombinationstherapie/Polypharmazie-Interaktionen von Psychopharmaka. Arzneimitteltherapie. 2014;32(12):361-370.
Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008;56(7):1333-1341. https://doi.org/10.1111/j.1532-5415.2008.01737.x
Lertxundi U, Domingo-Echaburu S, Hernandez R, Peral J, Medrano J. Expert-based drug lists to measure anticholinergic burden: similar names, different results: scores to measure anticholinergic burden. Psychogeriatrics. 2013;13(1):17-24. https://doi.org/10.1111/j.1479-8301.2012.00418.x
Woosley R, Romero K. Crediblemeds.org QT drugs list. AZCERT, Inc; 2020. https://crediblemeds.org/
Romero K, Woosley RL. Clarification to the www.qtdrugs.org updated lists. Pharmacoepidemiol Drug Saf. 2009;18(5):423-424. https://doi.org/10.1002/pds.1727
Laux G, Dietmaier O. Was sind Psychopharmaka? Psychopharmaka. Berlin: Springer; 2018:11-13.
Agresti A, Caffo B. Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures. Am Stat. 2000;54(4):280. https://doi.org/10.2307/2685779
Govaerts J, Boeyckens J, Lammens A, et al. Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital. Ther Adv Psychopharmacol. 2021;11:204512532110006. https://doi.org/10.1177/20451253211000610
Carmona-Huerta J, Castiello-de Obeso S, Ramírez-Palomino J, et al. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. BMC Psychiatry. 2019;19(1):78. https://doi.org/10.1186/s12888-019-2056-0
Nobili A, Licata G, Salerno F, et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507-519. https://doi.org/10.1007/s00228-010-0977-0
Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63(2):187-195. https://doi.org/10.1111/j.1365-2125.2006.02744.x
Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One. 2009;4(2):e4439. https://doi.org/10.1371/journal.pone.0004439
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Ceraso A, Lin JJ, Schneider-Thoma J, et al. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews. 2020;2020(8). https://doi.org/10.1002/14651858.cd008016.pub3.
Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H. Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. J Clin Psychiatry. 2010;71(01):14-25. https://doi.org/10.4088/JCP.08r04526gre
Barnes TR, Drake R, Paton C, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020;34(1):3-78. https://doi.org/10.1177/0269881119889296
AWMF. S3-Leitlinie/Nationale VersorgungsLeitlinie-Unipolare Depression-Langfassung. Version 5. AWMF-Register-Nr.: nvl-005; 2015. https://www.awmf.org/uploads/tx_szleitlinien/nvl-005l_S3_Unipolare_Depression_2017-05.pdf
American Psychiatric Association Practice Guidelines. Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. Am J Psychiatry. 2001;158(10):1-52.
O'Brien R, Wyke S, Guthrie B, Watt G, Mercer S. An ‘endless struggle’: a qualitative study of general practitioners' and practice nurses' experiences of managing multimorbidity in socio-economically deprived areas of Scotland. Chronic Illn. 2011;7(1):45-59. https://doi.org/10.1177/1742395310382461
Guthrie B, Payne K, Alderson P, McMurdo MET, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012;345:e6341. https://doi.org/10.1136/bmj.e6341
Marengoni A, Onder G. Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ. 2015;350:h1059. https://doi.org/10.1136/bmj.h1059
Pirnejad H, Amiri P, Niazkhani Z, et al. Preventing potential drug-drug interactions through alerting decision support systems: a clinical context based methodology. Int J Med Inform. 2019;127:18-26. https://doi.org/10.1016/j.ijmedinf.2019.04.006
Bayati S, Bastani P, Sagheb Z, Jamalabadi S, Samadbeik M. The performance implications of pharmacy information system at the university teaching hospitals of Shiraz, Iran: cluster approach. J Adv Pharm Technol Res. 2017;8(4):125. https://doi.org/10.4103/japtr.JAPTR_13_17
Alanazi A, Al Rabiah F, Gadi H, Househ M, Al DB. Factors influencing pharmacists' intentions to use pharmacy information systems. Inform Med Unlock. 2018;11:1-8. https://doi.org/10.1016/j.imu.2018.02.004
Azaz-Livshits T, Levy M, Sadan B, Shalit M, Geisslinger G, Brune K. Computerized surveillance of adverse drug reactions in hospital: pilot study. Br J Clin Pharmacol. 1998;45(3):309-314. https://doi.org/10.1046/j.1365-2125.1998.00685.x
Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med. 2004;164(7):785. https://doi.org/10.1001/archinte.164.7.785
Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: toward a unified view. MIS Q. 2003;27(3):425-478. https://doi.org/10.2307/30036540
Lupu AM, Clinebell K, Gannon JM, Ellison JC, Chengappa KNR. Reducing anticholinergic medication burden in patients with psychotic or bipolar disorders. J Clin Psychiatry. 2017;78(9):e1270-e1275. https://doi.org/10.4088/JCP.16m11269
Nosè M, Bighelli I, Castellazzi M, et al. Prevalence and correlates of QTc prolongation in Italian psychiatric care: cross-sectional multicentre study. Epidemiol Psychiatr Sci. 2016;25(6):532-540. https://doi.org/10.1017/S2045796015000906
Beach SR, Celano CM, Noseworthy PA, Januzzi JL, Huffman JC. QTc prolongation, Torsades de Pointes, and psychotropic medications. Psychosomatics. 2013;54(1):1-13. https://doi.org/10.1016/j.psym.2012.11.001
Hasnain M, Vieweg WVR. QTc interval prolongation and Torsade de Pointes associated with second-generation antipsychotics and antidepressants: a comprehensive review. CNS Drugs. 2014;28(10):887-920. https://doi.org/10.1007/s40263-014-0196-9