gms | German Medical Science

16th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

19.11. - 20.11.2009, Berlin

Development of a German list of potentially inappropriate medication in the elderly

Meeting Abstract

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  • corresponding author S. Holt - Philipp Klee-Institute for Clinical Pharmacology, HELIOS Klinikum Wuppertal, Germany
  • S. Schmiedl - Philipp Klee-Institute for Clinical Pharmacology, HELIOS Klinikum Wuppertal, Germany
  • P. A. Thürmann - Philipp Klee-Institute for Clinical Pharmacology, HELIOS Klinikum Wuppertal, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 16. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Berlin, 19.-20.11.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09gaa04

doi: 10.3205/09gaa04, urn:nbn:de:0183-09gaa044

Published: November 5, 2009

© 2009 Holt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: Certain drugs are classified as potentially inappropriate medication (PIM) for elderly patients due to their increased risk for causing adverse drug reactions [Laroche ML et al. 2009]. Since published international PIM lists may not be suitable for Germany, we are developing a German PIM list (, SP3).

Material and method: After an extensive literature search a preliminary German PIM list has been created including more than 130 different drugs of 20 drug classes. A web-based, modified two round Delphi survey [RAND Corporation 1969] with a German speaking expert panel (25 experts of 7 different specialties) has been performed using a 5-point Likert scale. For certain drugs, experts differentiated between high and low doses and immediate vs. extended release preparations, respectively. This resulted in additional medicines to be evaluated in the second round.

Results: 82 of the drugs stated in the preliminary list were rated as PIM for elderly patients, e.g. indomethacin and thioridazine. In contrast 26 drugs were rated as suitable for elderly patients, e.g. tramadol and risperidone. In 47 drugs, experts’ rating failed to make a clear decision after the second round. In case the prescription cannot be avoided due to lack of alternatives, the final PIM-list includes recommendations with regard to e.g. monitoring parameters and frequency of monitoring. Furthermore, for some drugs alternatives were suggested by the experts, like melperone as an alternative for thioridazine.

Conclusions: A considerable number of drugs were unanimously considered to be potentially inappropriate for elderly people. However, due to the complex clinical therapeutic needs of elderly people, a “yes-or-no” scheme may oversimplify drugs’ assessment in many instances. The final PIM list will be validated evaluating the relationship between usage of PIM and the occurrence of clinically relevant adverse effects in several cohorts of elderly German patients.

Acknowledgements: Supported by BMBF Fö-Nr. 01ET0721