gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

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Adverse drug reactions and potentially inappropriate medication for the elderly

Beers Listen und unerwünschte Arzneimittelwirkungen

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  • corresponding author Petra A. Thürmann - HELIOS Klinikum Wuppertal, Philipp Klee-Institute of Clinical Pharmacology, Wuppertal, Germany
  • Marietta Rottenkolber - Institute for Medical Informatics, Biometry and Epidemiology, University Munich, Munich, Germany
  • Sven Schmiedl - HELIOS Klinikum Wuppertal, Philipp Klee-Institute of Clinical Pharmacology, Wuppertal, Germany
  • Silke Müller - Institute of Clinical Pharmacology, University Rostock, Rostock, Germany
  • Bernd Drewelow - Institute of Clinical Pharmacology, University Rostock, Rostock, Germany
  • Katrin Farker - Institute of Clinical Pharmacology, University Jena, Jena, Germany
  • Marion Hippius - Institute of Clinical Pharmacology, University Jena, Jena, Germany
  • Werner Siegmund - Institute of Clinical Pharmacology, University Greifswald, Greifswald, Germany
  • Karen May - Institute of Clinical Pharmacology, University Greifswald, Greifswald, Germany
  • Jörg Hasford - Institute for Medical Informatics, Biometry and Epidemiology, University Munich, Munich, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa14

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/gaa2008/08gaa14.shtml

Published: November 6, 2008

© 2008 Thürmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Background and aim: In elderly patients certain drugs are classified as potentially inappropriate medication (PIM) due to their increased risk for causing adverse drug reactions (ADRs) [1]. However, there are contradictory data whether prescription of drugs classified as PIM are associated with a higher risk for ADRs [2].

Material and method: Data from the literature regarding prescribing frequencies and ADRs associated with PIM will be critically analysed with respect to the German healthcare system and further related to data of ADRs occurring in the elderly and documented in the database of the German Network of Regional Pharmacovigilance Centres (NRPZ). In addition, the frequency of ADRs associated with PIM in the database will be evaluated separately [3].

Results: Prescription of PIM has been associated with higher use of health care resources in some studies and was not related with an increased risk for ADRs in others. Analyses were conducted in different settings, including hospitals, ambulatory prescriptions as well as nursing homes, which could explain some of the observed differences. None of the studies followed a vigorous, prospective design. Drugs of the Beers list do account only for approximately 5% of ADRs resulting in hospitalisation in the German NRPZ. The majority of ADRs in the elderly are caused by antidiabetics, diuretics, antithrombotics and beta-blockers, i.e. drugs not classified as PIM. More over, drug-drug interactions were more frequently observed in the elderly as a cause for hospital admission (p<0.001). In a multivariate analysis, the risk for receiving PIM increased with the number of drugs prescribed.

Conclusion: In the database of the German NRPZ prescription of PIM did not play a relevant role in elderly patients for the occurrence of ADRs.

Supported by BfArM: Fo 2.1-68502-201

Outline

References

1.
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):2716-24.
2.
Jano E, Aparasu RR. Healthcare outcomes associated with beers' criteria: a systematic review. Ann Pharmacother. 2007;41(3):438-47.
3.
Platel Y, Rottenkolber M, Szymanski J, Thürmann PA, Hasford J; German Pharmacovigilance Study Group. The use of inappropriate medications in the old does not substantially contribute to the occurrence of serious adverse drug reactions leading to hospital admission. Basic Clin Pharmacol Toxicol. 2007;101:390-1.