Research Article
Year 2019,
Volume: 10 Issue: 4, 381 - 388, 13.12.2019
Abstract
Objective: Advanced
age, as a cause of increased prevalence of co-morbidities, is one of the main
risk factors for Alzheimer disease.
Co-morbidities accompanying the Alzheimer as well as the disease itself
elicit polypharmacy which means two or more drugs used concomitantly. One of
the undesirable results of polypharmacy is potential drug-drug interactions
(pDDI). The study aimed to evaluate the pDDIs
in Alzheimer patients.
Material-Method: Files
of patient who applied to a XXX Outpatient Clinic of a tertiary hospital in XXX
between 2016-2018 were evaluated retrospectively. Rate of polypharmacy,
presence and type of pDDI were determinated.
Results: In the
analyses of 115 files, mean age was 75.13+9.38 and frequency of polypharmacy
was calculated as 53.9%. Presence of 3 or more co-morbidites was associated
with polypharmacy. pDDI was detected in 77.4% of patients and type C
interaction was the most common type. Quetiapine, citalopram/escitalopram,
donepezil, risperidone and acetylsalicylic acid were the five drugs that
interacted with the maximum number of other medications.
Conclusion: The rate of polypharmacy and pDDI as a
consequence of polypharmacy could be higher in Alzheimer patients. Some pDDIs
could impair the therapeutic effects of Alzheimer drugs in addition to
undesirable effects. So the pDDI should be kept in mind when a new drug should
be added to Alzheimer patient.
References
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European Psychiatry 2013;28(1):40-8. 6. Doraiswamy PM, Leon J, Cummings JL, Marin D, Neumann PJ. Prevalence and impact of medical comorbidity in Alzheimer's disease. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:(3)M173-7. 7. Lawler E, Avila A. Alzheimer Disease: Monotherapy vs. Combination Therapy. American family physician 2017;95:452. 8. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC geriatrics 2017;17(1):230. 9. Yıldırım AB, Kılınç AY. Polypharmacy and drug interactions in elderly patients. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 2017;45: 17-21. 10. Rodvold KA, Kraus DM. Drug interactions involving anti-infective agents. In Antibiotic and Chemotherapy 2010;68–103. 11. Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Welte T, Böger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. International journal of clinical pharmacology and therapeutics 2000;38(11):504-13. 12. Kheshti R, Aalipour M, Namazi S. A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. Journal of research in pharmacy practice 2016;5(4):257-63. 13. “Lexicomp® Drug Interactions.” [Online]. Available: https://www.uptodate.com/drug-interactions/?source=responsive_home#di-analyze. 14. Maresova P, Mohelska H, Dolejs J, Kuca K. Socio-economic aspects of Alzheimer's disease. Current Alzheimer Research 2015;12(9):903-11. 15. Nebel RA, Aggarwal NT, Barnes LL. Understanding the impact of sex and gender in Alzheimer's disease: a call to action. Alzheimer's & Dementia 2008;14(9):1171-83. 16. Jetha S. Polypharmacy, the elderly, and deprescribing. The Consultant Pharmacist 2015;30(9): 527-32. 17. Savran M, Asci H. Evaluation of Drug Profile in Elderly Living in Nursing Home: Drug-Drug Interaction Analysis. SDÜ Tıp Fakültesi Dergisi 2018;25:361–9. 18. Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC geriatrics 2018;18(1):309. 19. Kim J, Parish AL. Polypharmacy and medication management in older adults. Nursing Clinics 2017;52(3):457-68. 20. Şayir ÇT, Toprak DE, Karaoğlu SA. Evaluation of polypharmacy and complementary therapy use in patients>= 65 years, attending to Family Medicine Outpatient Clinic of Şişli Etfal Training and Research Hospital. Turkish Journal of Family Practice 2014;18(1):35-41. 21. Gurwitz JH, Field TS, Harrold LR. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Jama 2003;289(9):1107-16. 22. Vaz FNC, Trombim LB, de Freitas GBL. Polypharmacy in Alzheimer's disease patients in Brazil: Guidance for pharmaceutical assistance. F1000Research 2017;6:1-12 23. García DS, Castro ES, Expósito I, et al. Comorbid conditions associated with Parkinson's disease: a longitudinal and comparative study with Alzheimer disease and control subjects. Journal of the neurological sciences 2017;373:210-5. 24. Björkman IK, Fastbom J, Schmidt IK, De Deus T, Tuñas C, Aneiros A, Torres MB. Drug-Drug Interactions in the Elderly. Annals of Pharmacotherapy 2002;36(11):1675-81. 25. Rahmawati FITA, Hidayati NURROCHMAH, Rochmah WASILAH. Potentiality of drug-drug interactions in hospitalized geriatric patients in a private hospital, Yogyakarta, Indonesia. Asian J Pharm Clin Res 2010;3(3):191-4. 26. Sönnerstam E, Sjölander M, Lövheim H, Gustafsson M. Clinically relevant drug–drug interactions among elderly people with dementia. European journal of clinical pharmacology 2018;74(10):1351-60. 27. Bogetti-Salazar M, González-González C, Juárez-Cedillo T, Sánchez-García S, Rosas-Carrasco O. Severe potential drug-drug interactions in older adults with dementia and associated factors. Clinics 2016;71(1):17-21. 28. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly. Drug safety 2007;30(10):911-8. 29. Ülger Z, Arıoğul S. Treatment of dementia.İç Hastalıkları Dergisi 2007;14:33-8. 30. Ah YM, Suh Y, Jun K, Hwang S, Lee JY. Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study. Basic & clinical pharmacology & toxicology 2018. 31. Zimmerman KM, Salow M, Skarf LM, Kostas T, Paquin A, Simone MJ, Rudolph J. Increasing anticholinergic burden and delirium in palliative care inpatients. Palliative medicine 2014;28(4):335-41. 32. Moraros J, Nwankwo C, Patten SB, Mousseau DD. The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta‐analysis. Depression and anxiety 2017;34(3):217-26. 33. Orgeta V, Tabet N, Nilforooshan R, Howard R. Efficacy of antidepressants for depression in Alzheimer’s disease: systematic review and meta-analysis. Journal of Alzheimer's Disease 2017;58(3):725-33. 34. Nagy CF, Kumar D, Perdomo CA, Wason S, Cullen EI, Pratt, RD. Concurrent administration of donepezil HCl and sertraline HCl in healthy volunteers: assessment of pharmacokinetic changes and safety following single and multiple oral doses. British journal of clinical pharmacology 2004;58:25-33. 35. Devanand DP, Mintzer J, Schultz SK, Andrews, HF, Sultzer, DL, de la Pena D, Levin B. Relapse risk after discontinuation of risperidone in Alzheimer's disease. New England Journal of Medicine 2012;367(16):1497-507. 36. Mathys M. Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder. Mental Health Clinician 2018;8(6):284-93. 37. Emre M. Dementia associated with Parkinson's disease. The Lancet Neurology 203;2(4):229-37. 38. Kurtz AL, Kaufer DI. Dementia in Parkinson’s disease. Current treatment options in neurology 2011;13(3):242-54. 39. Marras C, Austin PC, Bronskill SE, Diong C, Rochon PA. Antipsychotic Drug Dispensing in Older Adults With Parkinsonism. The American Journal of Geriatric Psychiatry 2018;26(12):1244-57. 40. Weintraub D, Chiang C, Kim HM, Wilkinson J, Marras C, Stanislawski B, Kales HC. Association of antipsychotic use with mortality risk in patients with Parkinson disease. JAMA neurology 2016;73(5):535-41. 41. Kumar PNS, Mohemmedali SP, Anish PK, Andrade C. Cognitive effects with rivastigmine augmentation of risperidone: A 12-month, randomized, double-blind, placebo-controlled study in schizophrenia. Indian journal of psychiatry 2017;59(2):219-24. 42. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. New England Journal of Medicine 1997;336(15):1108. 43. Bebbington A, Kulkarni R, Roberts P. Ginkgo biloba: persistent bleeding after total hip arthroplasty caused by herbal self-medication. The Journal of arthroplasty 2005;20(1):125-6. 44. Gardner CD, Zehnder JL, Rigby AJ, Nicholus JR, Farquhar JW. Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial. Blood Coagulation & Fibrinolysis 2007;18(8):787-93. 45. Wolf HR. Does Ginkgo biloba Special Extract EGb 761® Provide Additional Effects on Coagulation and Bleeding when Added to Acetylsalicylic Acid 500mg Daily?. Drugs in R & D 2006;7(3):163-72. 46. Ahmed A. Interaction Between Aspirin and Angiotensin‐Converting Enzyme Inhibitors: Should They Be Used Together in Older Adults with Heart Failure?. Journal of the American Geriatrics Society 2002;50(7):1293-6. 47. Pedone C, Cecchi E, Matucci R, Pahor M, Carosella L, Bernabei R, et al. Does aspirin attenuate the beneficial effect of ACE inhibitors in elderly people with heart failure?. Drugs & aging 2005;22(7):605-14. 48. Borghi C, Omboni S, Novo S, Vinereanu D, Ambrosio G, Ambrosioni E. Early treatment with zofenopril and ramipril in combination with acetyl salicylic acid in patients with left ventricular systolic dysfunction after acute myocardial infarction: results of a 5-year follow-up of patients of the Smile-4 Study. Journal of cardiovascular pharmacology 2017;69(5):298-304. 49. Hundal RS, Petersen KF, Mayerson AB, Randhawa PS, Inzucchi S, Shoelson SE, et al. Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes. The Journal of clinical investigation 2002;109(10):1321-6.
Year 2019,
Volume: 10 Issue: 4, 381 - 388, 13.12.2019
Abstract
References
- 1. Akdemir A, Cangöz B, Örsel S, Selekler K. Comparison of patients with mild cognitive impairment and patients with Alzheimer type dementia in terms of implicit memory performance. Turk Psikiyatri Derg 2007;18(2):118-28. 2. Maccioni RB, González A, Andrade V, V., Cortés N, Tapia JP, Guzmán-Martínez L. Alzheimer´ s Disease in the Perspective of Neuroimmunology. The open neurology journal 2018;12:50–6. 3. Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Fratiglioni L. Defeating Alzheimer’s disease and other dementias: a priority for European science and society. Lancet Neurol 2016;15(5):455–532. 4. Milani RV, Lavie CJ. Health care 2020: reengineering health care delivery to combat chronic disease. The American journal of medicine 2015;128:337-43. 5. Heun R, Schoepf D, Potluri R, Natalwala A. Alzheimer's disease and co-morbidity: increased prevalence and possible risk factors of excess mortality in a naturalistic 7-year follow-up. European Psychiatry 2013;28(1):40-8. 6. Doraiswamy PM, Leon J, Cummings JL, Marin D, Neumann PJ. Prevalence and impact of medical comorbidity in Alzheimer's disease. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:(3)M173-7. 7. Lawler E, Avila A. Alzheimer Disease: Monotherapy vs. Combination Therapy. American family physician 2017;95:452. 8. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC geriatrics 2017;17(1):230. 9. Yıldırım AB, Kılınç AY. Polypharmacy and drug interactions in elderly patients. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 2017;45: 17-21. 10. Rodvold KA, Kraus DM. Drug interactions involving anti-infective agents. In Antibiotic and Chemotherapy 2010;68–103. 11. Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Welte T, Böger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. International journal of clinical pharmacology and therapeutics 2000;38(11):504-13. 12. Kheshti R, Aalipour M, Namazi S. A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. Journal of research in pharmacy practice 2016;5(4):257-63. 13. “Lexicomp® Drug Interactions.” [Online]. Available: https://www.uptodate.com/drug-interactions/?source=responsive_home#di-analyze. 14. Maresova P, Mohelska H, Dolejs J, Kuca K. Socio-economic aspects of Alzheimer's disease. Current Alzheimer Research 2015;12(9):903-11. 15. Nebel RA, Aggarwal NT, Barnes LL. Understanding the impact of sex and gender in Alzheimer's disease: a call to action. Alzheimer's & Dementia 2008;14(9):1171-83. 16. Jetha S. Polypharmacy, the elderly, and deprescribing. The Consultant Pharmacist 2015;30(9): 527-32. 17. Savran M, Asci H. Evaluation of Drug Profile in Elderly Living in Nursing Home: Drug-Drug Interaction Analysis. SDÜ Tıp Fakültesi Dergisi 2018;25:361–9. 18. Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC geriatrics 2018;18(1):309. 19. Kim J, Parish AL. Polypharmacy and medication management in older adults. Nursing Clinics 2017;52(3):457-68. 20. Şayir ÇT, Toprak DE, Karaoğlu SA. Evaluation of polypharmacy and complementary therapy use in patients>= 65 years, attending to Family Medicine Outpatient Clinic of Şişli Etfal Training and Research Hospital. Turkish Journal of Family Practice 2014;18(1):35-41. 21. Gurwitz JH, Field TS, Harrold LR. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Jama 2003;289(9):1107-16. 22. Vaz FNC, Trombim LB, de Freitas GBL. Polypharmacy in Alzheimer's disease patients in Brazil: Guidance for pharmaceutical assistance. F1000Research 2017;6:1-12 23. García DS, Castro ES, Expósito I, et al. Comorbid conditions associated with Parkinson's disease: a longitudinal and comparative study with Alzheimer disease and control subjects. Journal of the neurological sciences 2017;373:210-5. 24. Björkman IK, Fastbom J, Schmidt IK, De Deus T, Tuñas C, Aneiros A, Torres MB. Drug-Drug Interactions in the Elderly. Annals of Pharmacotherapy 2002;36(11):1675-81. 25. Rahmawati FITA, Hidayati NURROCHMAH, Rochmah WASILAH. Potentiality of drug-drug interactions in hospitalized geriatric patients in a private hospital, Yogyakarta, Indonesia. Asian J Pharm Clin Res 2010;3(3):191-4. 26. Sönnerstam E, Sjölander M, Lövheim H, Gustafsson M. Clinically relevant drug–drug interactions among elderly people with dementia. European journal of clinical pharmacology 2018;74(10):1351-60. 27. Bogetti-Salazar M, González-González C, Juárez-Cedillo T, Sánchez-García S, Rosas-Carrasco O. Severe potential drug-drug interactions in older adults with dementia and associated factors. Clinics 2016;71(1):17-21. 28. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly. Drug safety 2007;30(10):911-8. 29. Ülger Z, Arıoğul S. Treatment of dementia.İç Hastalıkları Dergisi 2007;14:33-8. 30. Ah YM, Suh Y, Jun K, Hwang S, Lee JY. Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study. Basic & clinical pharmacology & toxicology 2018. 31. Zimmerman KM, Salow M, Skarf LM, Kostas T, Paquin A, Simone MJ, Rudolph J. Increasing anticholinergic burden and delirium in palliative care inpatients. Palliative medicine 2014;28(4):335-41. 32. Moraros J, Nwankwo C, Patten SB, Mousseau DD. The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta‐analysis. Depression and anxiety 2017;34(3):217-26. 33. Orgeta V, Tabet N, Nilforooshan R, Howard R. Efficacy of antidepressants for depression in Alzheimer’s disease: systematic review and meta-analysis. Journal of Alzheimer's Disease 2017;58(3):725-33. 34. Nagy CF, Kumar D, Perdomo CA, Wason S, Cullen EI, Pratt, RD. Concurrent administration of donepezil HCl and sertraline HCl in healthy volunteers: assessment of pharmacokinetic changes and safety following single and multiple oral doses. British journal of clinical pharmacology 2004;58:25-33. 35. Devanand DP, Mintzer J, Schultz SK, Andrews, HF, Sultzer, DL, de la Pena D, Levin B. Relapse risk after discontinuation of risperidone in Alzheimer's disease. New England Journal of Medicine 2012;367(16):1497-507. 36. Mathys M. Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder. Mental Health Clinician 2018;8(6):284-93. 37. Emre M. Dementia associated with Parkinson's disease. The Lancet Neurology 203;2(4):229-37. 38. Kurtz AL, Kaufer DI. Dementia in Parkinson’s disease. Current treatment options in neurology 2011;13(3):242-54. 39. Marras C, Austin PC, Bronskill SE, Diong C, Rochon PA. Antipsychotic Drug Dispensing in Older Adults With Parkinsonism. The American Journal of Geriatric Psychiatry 2018;26(12):1244-57. 40. Weintraub D, Chiang C, Kim HM, Wilkinson J, Marras C, Stanislawski B, Kales HC. Association of antipsychotic use with mortality risk in patients with Parkinson disease. JAMA neurology 2016;73(5):535-41. 41. Kumar PNS, Mohemmedali SP, Anish PK, Andrade C. Cognitive effects with rivastigmine augmentation of risperidone: A 12-month, randomized, double-blind, placebo-controlled study in schizophrenia. Indian journal of psychiatry 2017;59(2):219-24. 42. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. New England Journal of Medicine 1997;336(15):1108. 43. Bebbington A, Kulkarni R, Roberts P. Ginkgo biloba: persistent bleeding after total hip arthroplasty caused by herbal self-medication. The Journal of arthroplasty 2005;20(1):125-6. 44. Gardner CD, Zehnder JL, Rigby AJ, Nicholus JR, Farquhar JW. Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial. Blood Coagulation & Fibrinolysis 2007;18(8):787-93. 45. Wolf HR. Does Ginkgo biloba Special Extract EGb 761® Provide Additional Effects on Coagulation and Bleeding when Added to Acetylsalicylic Acid 500mg Daily?. Drugs in R & D 2006;7(3):163-72. 46. Ahmed A. Interaction Between Aspirin and Angiotensin‐Converting Enzyme Inhibitors: Should They Be Used Together in Older Adults with Heart Failure?. Journal of the American Geriatrics Society 2002;50(7):1293-6. 47. Pedone C, Cecchi E, Matucci R, Pahor M, Carosella L, Bernabei R, et al. Does aspirin attenuate the beneficial effect of ACE inhibitors in elderly people with heart failure?. Drugs & aging 2005;22(7):605-14. 48. Borghi C, Omboni S, Novo S, Vinereanu D, Ambrosio G, Ambrosioni E. Early treatment with zofenopril and ramipril in combination with acetyl salicylic acid in patients with left ventricular systolic dysfunction after acute myocardial infarction: results of a 5-year follow-up of patients of the Smile-4 Study. Journal of cardiovascular pharmacology 2017;69(5):298-304. 49. Hundal RS, Petersen KF, Mayerson AB, Randhawa PS, Inzucchi S, Shoelson SE, et al. Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes. The Journal of clinical investigation 2002;109(10):1321-6.
There are 1 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Publication Date | December 13, 2019 |
| Submission Date | July 31, 2019 |
| Published in Issue | Year 2019 Volume: 10 Issue: 4 |
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