MedPage Today
by Nancy Walsh
24 Aug 12

Inappropriate drug prescribing for the elderly is still common, with possible risks in about one in five prescriptions, a Dutch systematic review found.
In 19 published studies, the median rate of inappropriate prescriptions was 20%, with a range of 2.9% to 38.5%, according to Dedan Opondo, PhD, of the University of Amsterdam, and colleagues.

Darvon (propoxyphene), Cardura (doxazosin), Benadryl and others (diphenhydramine), and Elavil (amitriptyline) and similar class drugs were prescribed for older individuals at rates exceeding 3 percent to 4 percent, researchers reported online in PLoS One. More than one-third of at-risk older individuals experience drug-related adverse events, even in cases where less hazardous options are available, they noted.

"Despite intensified efforts to scrutinize and improve the quality of medication prescription among elderly persons in the primary care setting, inappropriate medication prescriptions are still common," wrote according to Dedan Opondo, PhD, of the University of Amsterdam, and colleagues.

To explore this ongoing problem, the researchers searched the literature for studies assessing the use in older patients of multiple types of drugs including analgesics (painkillers), hypnotics (to induce sleep), antihypertensives (reducing blood pressure), and anticholinergics (used to treat numerous conditions, including vertigo, insomnia, gastritis, cystitis and asthma).

Among the nonsteroidal anti-inflammatory drugs, they found that Darvon and other propoxyphenes, which is classified as low risk, was the most-common inappropriate medication. The higher-risk Demerol, or pentazocine and meperidine, were the least common, being prescribed for the elderly.

For antiarrhythmics, Lanoxin, Digitek, and Lanoxicaps (digoxin) was the most commonly used inappropriate medication. Norpace (disopyramide) was the least common. Digoxin is considered low risk and Norpace (disopyramide) is considered high risk.

Within the anticholinergic class of drugs, Benadryl (diphenhydramine) was most often used. The least common were the belladonna alkaloids, which also are high risk.

The most frequently prescribed inappropriate anti-clotting medications were high-risk Ticlid (ticlopidine), and low-risk Persantine (dipyridamole).

Among antidepressants, Elavil and others like it (amitriptyline) was the most common and Atapine and drugs like it (doxepin) was the least used. Both are considered high risk.

Cardura (doxazosin), a low-risk agent, was the most common inappropriate antihypertensive prescribed, while Ismelin (guanethidine), a high-risk drug, was the least prescribed.

For muscle relaxants, Flexeril and others (cyclobenzaprine) topped the list, while Skelaxin (metaxalone) was lowest. Both are high risk.

And among sedative hypnotics, all of which are considered high risk, Valium (diazepam) was the most used, and both Xanax (alprazolam) and Serax (oxazepam) had the lowest rates.

Because the risks can vary widely in the elderly within drug classes, clinicians should attempt to avoid the riskiest agents and systems need to be in place to assist them, according to the authors of the review.



http://www.medpagetoday.com/PrimaryC...riatrics/34357