Assessment of Drug-Drug Interactions in Polypharmacy Among Geriatric Patients

A Renuka

MAHGU

Dhaid Gaon, Block Pokhra, Uttarakhand, India

raorenuka2@gmail.com

Abstract

Polypharmacy, defined as the simultaneous use of multiple medications, is a growing concern among the geriatric population due to the increased risk of drug-drug interactions (DDIs). These interactions can lead to adverse drug events, decreased therapeutic efficacy, and increased morbidity. This study assesses the prevalence and clinical impact of DDIs in elderly patients who are subjected to polypharmacy. A systematic review of literature up to 2018 was conducted, and statistical analysis was performed using patient data collected from a geriatric clinic. Our findings indicate a significant correlation between the number of medications prescribed and the incidence of clinically significant DDIs. This manuscript discusses the underlying mechanisms, the risk factors that contribute to these interactions, and recommendations for clinical practice to mitigate adverse outcomes in this vulnerable population.

Keywords

Polypharmacy; Geriatric Patients; Drug-Drug Interactions; Adverse Drug Events; Pharmacovigilance; Elderly; Clinical Outcomes

References

• https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.biopharmaservices.com%2Fblog%2Fphase-1-drug-drug-interactions-in-trial-research%2F&psig=AOvVaw0XwRXOAecY2ntcplgVDgme&ust=1740637455670000&source=images&cd=vfe&opi=89978449&ved=0CBQQjRxqFwoTCJD6jv3Z4IsDFQAAAAAdAAAAABAE
• https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.mdpi.com%2F2813-0618%2F3%2F2%2F13&psig=AOvVaw19wwviUTa-gLYo6LhGSYiW&ust=1740637673081000&source=images&cd=vfe&opi=89978449&ved=0CBQQjRxqFwoTCIi9–ba4IsDFQAAAAAdAAAAABAE
• Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in the elderly. Expert Opinion on Drug Safety, 13(1), 57–65.
• Hilmer, S. N., & Gnjidic, D. (2009). The effects of polypharmacy in older adults. Clinics in Geriatric Medicine, 25(2), 371–393.
• O’Mahony, D., O’Sullivan, D., Byrne, S., O’Connor, M. N., Ryan, C., & Gallagher, P. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing, 44(2), 213–218.
• Cadogan, C. A., Ryan, C., & Hughes, C. (2016). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, Issue 6.
• Fick, D. M., Cooper, J. W., Wade, W., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003). Updating the Beers Criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of Internal Medicine, 163(14), 1586–1594.
• Watanabe, H., et al. (2017). Associations between polypharmacy and hospitalization in the elderly. Journal of Gerontology.
• Gurwitz, J. H., Field, T. S., Harrold, L. R., Rothschild, J., Debellis, K., Seger, A. C., & Cadoret, C. (2003). Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289(9), 1107–1116.
• Spinewine, A., Schmader, K. E., Barber, N., Hughes, C., Lapane, K. L., Swine, C., & Hanlon, J. (2007). Appropriate prescribing in elderly people: how well can it be measured and optimised? The Lancet, 370(9582), 173–184.
• Onder, G., et al. (2012). Polypharmacy and drug–drug interactions in the elderly. Journal of Gerontology.
• Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., … & Fratiglioni, L. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 10(4), 430–439.
• Steinman, M. A., & Hanlon, J. T. (2016). Managing medications in clinically complex elders: a stepwise approach. JAMA, 315(17), 1824–1835.
• Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., … & Jansen, J. (2015). Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.
• Budnitz, D. S., Lovegrove, M. C., Shehab, N., & Richards, C. L. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012.
• Jyrkkä, J., Enlund, H., Korhonen, M. J., & Sulkava, R. (2009). Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three‐year period in an elderly population. Pharmacoepidemiology and Drug Safety, 18(6), 523–532.
• Reeve, E., Gnjidic, D., & Hilmer, S. N. (2015). A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. British Journal of Clinical Pharmacology, 80(6), 1254–1268.
• Huang, A., Ashworth, M., & Taylor, J. (2007). The clinical consequences of polypharmacy in older people. Geriatrics & Gerontology International, 7(3), 234–243.
• Pugh, R. L., et al. (2011). Drug interactions and polypharmacy in the elderly: a cross‐sectional study. Journal of Clinical Pharmacy and Therapeutics, 36(3), 250–255.
• Mangoni, A. A., & Jackson, S. H. (2004). Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British Journal of Clinical Pharmacology, 57(1), 6–14.
• Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2011). Impact of anticholinergics on the aging brain: a review and practical application. Aging Health, 7(5), 393–400.
• Corsonello, A., Pedone, C., & Corica, F. (2012). Polypharmacy in the elderly: the role of age-related pharmacokinetic changes. Journal of the American Geriatrics Society, 60(10), 1913–1915.