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Mansbart F, Kienberger G, Sönnichsen A, Mann E. Efficacy and safety of adrenergic alpha-1 receptor antagonists in older adults: a systematic review and meta-analysis supporting the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr 2022; 22:771. [PMID: 36171560 PMCID: PMC9516834 DOI: 10.1186/s12877-022-03415-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adrenergic alpha-1 receptor antagonists (alpha-1 antagonists) are frequently used medications in the management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and in the management of therapy-resistant arterial hypertension, two conditions frequently found in older adults. This systematic review aims at presenting a complete overview of evidence over the benefits and risks of alpha-1 antagonist treatment in people ≥ 65 years, and at deriving recommendations for a safe application of alpha-1 antagonists in older adults from the evidence found. Methods A comprehensive literature search was performed (last update March 25th 2022) including multiple databases (Medline/Pubmed, Embase, the Cochrane Library) and using the PICOS framework to define search terms. The selection of the studies was done by two independent reviewers in a two-step approach, followed by a systematic data extraction. Quality appraisal was performed for each study included using standardised appraisal tools. The studies retrieved and additional literature were used for the development of recommendations, which were rated for strength and quality according to the GRADE methodology. Results Eighteen studies were included: 3 meta-analyses, 6 randomised controlled trials and 9 observational trials. Doxazosin in the management of arterial hypertension was associated with a higher risk of cardiovascular disease, particularly heart failure, than chlorthalidone. Regarding treatment of LUTS suggestive of BPH, alpha-1 antagonists appeared to be effective in the relief of urinary symptoms and improvement of quality of life. They seemed to be less effective in preventing disease progression. Analyses of the risk profile indicated an increase in vasodilation related adverse events and sexual adverse events for some agents. The risk of falls and fractures as well as the effects of long-term treatment remained unclear. All meta-analyses and 5 out of 6 interventional studies were downgraded in the quality appraisal. 7 out of 9 observational studies were of good quality. Conclusions It cannot be recommended to use doxazosin as first-line antihypertensive agent neither in older adults nor in younger patients. In the management of BPH alpha-1 antagonists promise to effectively relieve urinary symptoms with uncertainty regarding their efficacy in preventing long-term progression events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03415-7.
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Affiliation(s)
- Felix Mansbart
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Gerda Kienberger
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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Renoncourt T, Saint F, Bennis Y, Mondet L, Bloch F. Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons. J Am Med Dir Assoc 2022; 23:992-997. [PMID: 34653381 DOI: 10.1016/j.jamda.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven. DESIGN This was a descriptive study of drug prescriptions in a geriatric academic center. SETTING AND PARTICIPANTS We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital. METHODS We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. RESULTS A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08-10.2). CONCLUSIONS AND IMPLICATIONS In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.
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Affiliation(s)
- Thomas Renoncourt
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France.
| | - Fabien Saint
- Department of Urology and Transplantation, CHU Amiens-Picardie, Amiens, France; EPROAD Laboratory EA 4669, Picardie Jules Verne University, Amiens, France
| | - Youssef Bennis
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Lisa Mondet
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Frédéric Bloch
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France
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Hiremath S, Ruzicka M, Petrcich W, McCallum MK, Hundemer GL, Tanuseputro P, Manuel D, Burns K, Edwards C, Bugeja A, Magner P, McCormick B, Garg AX, Rhodes E, Sood MM. Alpha-Blocker Use and the Risk of Hypotension and Hypotension-Related Clinical Events in Women of Advanced Age. Hypertension 2019; 74:645-651. [DOI: 10.1161/hypertensionaha.119.13289] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alpha-blockers (ABs) are commonly prescribed as part of a multidrug regimen in the management of hypertension. We set out to assess the risk of hypotension and related adverse events with AB use compared with other blood pressure (BP) lowering drugs using a population-based, retrospective cohort study of women (≥66 years) between 1995 and 2015 in Ontario, Canada. Cox proportional hazards examined the association of AB use and hypotension and related events (syncope, fall, and fracture) compared with other BP lowering drugs matched via a high dimensional propensity score. The primary outcome was a composite of hospitalizations for hypotension and related events (syncope, fractures, and falls) within 1 year. From 734 907 eligible women, 14 106 were dispensed an AB (mean age, 75.7; standard deviation 6.9 years, median follow-up 1 year) and matched to 14 106 dispensed other BP lowering agents. The crude incidence rate of hypotension and related events was 95.7 (95% CI [confidence interval], 90.4–101.1, events 1214 [8.6%]) with AB and 79.8 (95% CI, 74.9–84.7 per 1000 person-years, events 1025 [7.3%]) with other BP lowering medications (incident rate ratio, 1.20; 95% CI, 1.10–1.30). The risk was higher for hypotension (hazard ratio, 1.71; 95% CI, 1.33–2.20) and syncope (hazard ratio, 1.44; 95% CI, 1.18–1.75) with no difference in falls, fractures, adverse cardiac events, or all-cause mortality. Treatment of hypertension in women with ABs is associated with a higher risk of hypotension and hypotension-related events compared with other BP lowering agents. Our findings suggest that ABs should be used with caution, even as add on therapy for hypertension.
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Affiliation(s)
- Swapnil Hiremath
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Marcel Ruzicka
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - William Petrcich
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Megan K. McCallum
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Gregory L. Hundemer
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Tanuseputro
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Douglas Manuel
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Kevin Burns
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
| | - Cedric Edwards
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Ann Bugeja
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Magner
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Bruyere Research Institute, the Ottawa Hospital, Canada (P.T.)
| | - Brendan McCormick
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Amit X. Garg
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
- Division of Nephrology, Western University, London, Canada (A.X.G.)
| | - Emily Rhodes
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Manish M. Sood
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
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Kao WH, Kuo CF, Chou IJ, See LC, Huang WK, Chiou MJ, Zhang W, Doherty M, Wang CC, Hsu JT, Chen HH, Hong JH. Prostate-selective α antagonists increase fracture risk in prostate cancer patients with and without a history of androgen deprivation therapy: a nationwide population-based study. Oncotarget 2018; 9:5263-5273. [PMID: 29435177 PMCID: PMC5797048 DOI: 10.18632/oncotarget.23828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 12/24/2017] [Indexed: 11/25/2022] Open
Abstract
Introductions Prostate-selective α antagonists are recommended for relief of lower urinary tract symptoms in prostate cancer patients despite uncertainty of fracture risk as an addition to androgen deprivation therapy (ADT). The purpose of this study is to estimate fracture risk associated with these medications in prostate cancer patients who did and did not receive ADT. Methods The Taiwan National Health Insurance database was used to identify prostate cancer patients. We identified all 90-day person-quarters exposed to and not exposed to prostate-selective α antagonists. A generalized estimating equation model was used to estimated adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for fracture associated with prostate-selective α antagonists with consideration for confounding by indication bias using propensity score. Results During 1997–2008, 16,601 persons received a diagnosis of prostate cancer, among whom 13,694 received ADT. Among prostate cancer patients receiving ADT, fracture was significantly more common in person-quarters with prostate-selective α antagonist use than in quarters without such treatment (OR, 1.08; 95% CI, 1.00–1.18). Prostate-selective α antagonist use was most strongly associated with femur fracture (OR, 1.22; 95% CI, 1.09–1.38), followed by skull fracture (OR, 1.29; 95% CIs: 0.93–1.80). Among patients who did not receive ADT, fracture was more common in person-quarters with prostate-selective α antagonist use than in those without medication use (OR, 1.19; 95% CI, 0.91–1.55). Conclusions Prostate-selective α antagonist is associated with an increased fracture risk, particular for fractures in skull and femur. Patients should be well-informed on this potential risk before taking prostate-selective α antagonists.
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Affiliation(s)
- Wei-Heng Kao
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - I-Jun Chou
- Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Kuan Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Jiun Chiou
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsien-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan.,Radiation Biology Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan, Taiwan
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6
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Welk B, McArthur E, Fraser LA, Hayward J, Dixon S, Hwang YJ, Ordon M. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study. BMJ 2015; 351:h5398. [PMID: 26502947 PMCID: PMC4620650 DOI: 10.1136/bmj.h5398] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
STUDY QUESTION Do men starting treatment with prostate-specific α antagonists have increased risk of fall and fracture? METHODS Administrative datasets from the province of Ontario, Canada, that contain patient level data were used to generate a cohort of 147,084 men aged ≥ 66 years who filled their first outpatient prescription for prostate-specific α antagonists tamsulosin, alfuzosin, or silodosin between June 2003 and December 2013 (exposed men) plus an equal sized cohort matched 1:1 (using a propensity score model) who did not initiate α antagonist therapy. The primary outcome was a hospital emergency room visit or inpatient admission for a fall or fracture in the 90 days after exposure. STUDY ANSWER AND LIMITATIONS The men exposed to prostate-specific α antagonist had significantly increased risks of falling (odds ratio 1.14 (95% CI 1.07 to 1.21), absolute risk increase 0.17% (0.08 to 0.25%)) and of sustaining a fracture (odds ratio 1.16 (1.04 to 1.29), absolute risk increase 0.06% (0.02 to 0.11%)) compared with the unexposed cohort. This increased risk was not observed in the period before α antagonist use. Secondary outcomes of hypotension and head trauma were also significantly increased in the exposed cohort (odds ratios 1.80 (1.59 to 2.03) and 1.15 (1.04 to 1.27) respectively). The two cohorts were similar across 98 different covariates including demographics, comorbid conditions, medication use, healthcare use, and prior medical investigation. Potential unmeasured confounders, such as physical deconditioning, mobility impairment, and situational risk factors, may exist. The data used to identify the primary outcomes had limited sensitivity, so the absolute risks of the outcomes are probably underestimates. The study only included men ≥ 66 years old, and 84% of exposed men were prescribed tamsulosin, so results may not be generalizable to younger men, and there may not be statistical power to show small differences in outcomes between the drugs. WHAT THIS STUDY ADDS Prostate-specific α antagonists are associated with a small but significant increased risk of fall, fracture, and head trauma, probably as a result of induced hypotension. FUNDING, COMPETING INTERESTS, DATA SHARING This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site through the Kidney, Dialysis, and Transplantation (KDT) research program. BW has received a research grant from Astellas, and L-AF does consultancy for Amgen.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London ON N6A 4V2, Ontario, Canada Institute for Clinical Evaluative Sciences, London, Ontario Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, London, Ontario
| | | | - Jade Hayward
- Institute for Clinical Evaluative Sciences, London, Ontario
| | - Stephanie Dixon
- Institute for Clinical Evaluative Sciences, London, Ontario Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Y Joseph Hwang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario
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Lai CL, Kuo RNC, Chen HM, Chen MF, Chan KA, Lai MS. Risk of hip/femur fractures during the initiation period of α-adrenoceptor blocker therapy among elderly males: a self-controlled case series study. Br J Clin Pharmacol 2015; 80:1208-18. [PMID: 25924025 DOI: 10.1111/bcp.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/18/2015] [Accepted: 04/24/2015] [Indexed: 01/23/2023] Open
Abstract
AIMS This study aimed to evaluate the risk of hip/femur fractures during the initiation period of α-adrenoceptor blocker therapy using the National Health Insurance claims database, Taiwan, with a self-controlled case series design. METHODS All male beneficiaries aged over 50 years as of 2007, who were incident users of α-adrenoceptor blockers and also had a diagnosis of hip/femur fracture within the 2007-2009 study period were identified. The first day when the α-adrenoceptor blocker was prescribed was set as the index date. We partitioned the initial 21 day period following the index date as the post-exposure risk period 1, days 22-60 after the index date as the post-exposure risk period 2, the 21 day period prior to the index date as the pre-exposure risk period 1 and days 22-60 prior to the index date as the pre-exposure risk period 2. The remainder of the study period was defined as the unexposed period. The incidence rate ratio (IRR) of hip/femur fractures within each risk period compared with the unexposed period was estimated using a conditional Poisson regression model. RESULTS A total of 5875 men were included. Compared with the unexposed period, the IRR of hip/femur fractures was 1.36 (95% confidence interval 1.06, 1.74, P = 0.017) within the post-exposure risk period 1 for patients without concomitant prescriptions of anti-hypertensive agents. CONCLUSIONS Use of α-adrenoceptor blockers was associated with a small but significant increase in the risk of hip/femur fractures during the early initiation period in patients without concomitant prescriptions of anti-hypertensive agents.
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Affiliation(s)
- Chao-Lun Lai
- Department of Internal Medicine and Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Raymond Nien-Chen Kuo
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei.,Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei
| | - Ho-Min Chen
- Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei
| | - Ming-Fong Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Kinwei Arnold Chan
- Department of Medical Research, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei
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Chen Y, Zhu LL, Zhou Q. Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Ther Clin Risk Manag 2014; 10:437-48. [PMID: 24966681 PMCID: PMC4063859 DOI: 10.2147/tcrm.s63756] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. MATERIALS AND METHODS Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. RESULTS Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. CONCLUSION Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls.
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Affiliation(s)
- Ying Chen
- Liaison Office of Geriatric VIP Patients, Zhejiang University, Hangzhou, People's Republic of China
| | - Ling-Ling Zhu
- First Geriatric VIP Ward, Division of Nursing, Zhejiang University, Hangzhou, People's Republic of China
| | - Quan Zhou
- Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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9
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Alpha-adrenergic blocker mediated osteoblastic stem cell differentiation. Biochem Biophys Res Commun 2011; 416:232-8. [DOI: 10.1016/j.bbrc.2011.09.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/20/2011] [Indexed: 11/30/2022]
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10
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Vestergaard P, Rejnmark L, Mosekilde L. Risk of fractures associated with treatment for benign prostate hyperplasia in men. Osteoporos Int 2011; 22:731-7. [PMID: 20552327 DOI: 10.1007/s00198-010-1320-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/01/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED Treatment of benign prostate hyperplasia with α-blockers may affect blood pressure while treatment with 5-α-reductase inhibitors may affect conversion of testosterone potentially leading to osteoporosis. In our study, neither 5-α-reductase inhibitors nor α-blockers were associated with negative effects on fractures, α-blockers perhaps being associated with a limited decrease in fractures. INTRODUCTION The objective is to study fracture risk associated with drugs for benign prostate hyperplasia. The hypotheses were that (1) α-blockers may elevate fracture risk by causing presyncope/falls and (2) 5-α-reductase inhibitors may elevate fracture risk by lowering dihydrotestosterone. METHODS This is a nationwide case-control study using all 9,719 male fracture patients aged ≥60 years in the year 2000 as cases and drawing 29,156 age- and gender-matched controls. The main exposure was the use of the drugs mentioned above for benign prostate hyperplasia. Confounder control included social variables, contacts to hospitals and general practitioners, alcoholism and other variables. RESULTS For the 5-α-reductase inhibitors, no change in overall risk of fractures was seen. No change in risk of hip, spine and forearm fractures was present. For the α-blockers, a decrease in overall risk of fractures was seen, as well as a decrease in the risk of hip and spine fractures, but only at average doses >0.5 defined daily doses per day. No decrease was seen for forearm fractures. A decreasing risk of any fracture, hip fractures and spine fractures were seen with increasing dose of α-blockers, while no such association was seen for the forearm fractures. CONCLUSION Neither the 5-α-reductase inhibitors nor α-blockers were associated with negative effects on fracture risk. A small trend towards a decrease in fracture risk may be present for the α-blockers. However, more research is needed to confirm if this trend is real.
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Affiliation(s)
- P Vestergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
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11
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Parsons JK, Mougey J, Lambert L, Wilt TJ, Fink HA, Garzotto M, Barrett-Connor E, Marshall LM. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int 2009; 104:63-8. [PMID: 19154508 DOI: 10.1111/j.1464-410x.2008.08317.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the association of lower urinary tract symptoms (LUTS) with the risk of falls in elderly community-dwelling men. SUBJECTS AND METHODS We evaluated 5872 participants in the Osteoporotic Fractures in Men, a prospective cohort study of risk factors for falls and osteoporotic fractures among community-dwelling men aged > or =65 years. The primary outcome was the 1-year cumulative incidence of falls in men with moderate or severe, vs mild LUTS at baseline, as measured by the American Urological Association Symptom Index. We used Poisson regression models and considered multiple variables as potential confounders. RESULTS At baseline, 3188 (54%) reported mild, 2301 (39%) moderate, and 383 (7%) severe LUTS. Compared with men who had mild symptoms, the adjusted 1-year cumulative incidence of falls was significantly higher among men with moderate or severe LUTS. The risk of at least one fall was increased by 11% among those with moderate (relative risk 1.11, 95% confidence interval, CI, 1.01-1.22; P = 0.02) and by 33% among those with severe LUTS (1.33, 1.15-1.53; P < 0.001). Further, those with moderate LUTS had a 21% (1.21, 1.05-1.40; P = 0.01) and those with severe LUTS a 63% (1.63, 1.31-2.02; P < 0.001) greater risk of at least two falls. LUTS most strongly associated with falls were urinary urgency, difficulty initiating urination, and nocturia. CONCLUSIONS Moderate and severe LUTS independently increase the 1-year risk of falls, particularly recurrent falls, in community-dwelling older men. Because of the serious consequences of falls, these results might justify the routine assessment of LUTS with a validated questionnaire in the primary care of this population.
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Affiliation(s)
- J Kellogg Parsons
- Department of Surgery, Division of Urology, University of California, San Diego, CA, USA.
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Lee J, Choi NK, Jung SY, Kim YJ, Seong JM, Oh SJ, Park BJ. The Risk of Fracture with Taking Alpha Blockers for Treating Benign Prostatic Hyperplasia. J Prev Med Public Health 2009; 42:165-70. [DOI: 10.3961/jpmph.2009.42.3.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
| | - Nam-Kyoung Choi
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
- Medical Research Center, Seoul National University, Korea
| | - Sun-Young Jung
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
| | - Ye-Jee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
| | - Jong-Mi Seong
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
- Medical Research Center, Seoul National University, Korea
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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