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Kim E, Kim S, Suh HS. Use of gastrointestinal prokinetics and the risk of parkinsonism: A population-based case-crossover study. Pharmacoepidemiol Drug Saf 2023; 32:1378-1386. [PMID: 37491627 DOI: 10.1002/pds.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 05/03/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The disease burden of parkinsonism is extremely costly in the United States. Unlike Parkinson's disease, drug-induced parkinsonism (DIP) is acute and reversible; exploring the causative drug is important to prevent DIP in patients at high-risk of parkinsonism. OBJECTIVE To examine whether the use of gastrointestinal (GI) prokinetics is associated with an increased risk of parkinsonism. METHODS We conducted a case-crossover study using nationally representative data. We included patients who were newly diagnosed with parkinsonism (ICD-10 G20, G21.1, G25.1) between January 1, 2007 and December 1, 2015. The first prescription date of G20, G21.1, or G25.1 diagnoses was defined as the index date (0 day). Patients with prior extrapyramidal and movement disorders or brain tumors were excluded. We assessed the exposure within the risk (0-29 days) and control periods (60-89 days), before or on the index date. Conditional logistic regression estimated the adjusted odds ratio (aOR) for parkinsonism. RESULTS Overall, 2268 and 1674 patients were exposed to GI prokinetics during the risk and control periods, respectively. The use of GI prokinetics significantly increased the occurrence of parkinsonism (aOR = 2.31; 95% Confidence Interval [CI], 2.06-2.59). The use of GI prokinetics was associated with a higher occurrence of parkinsonism in elderly patients (≥65 years old; aOR = 2.69; 95% CI, 2.30-3.14) than in younger patients (aOR = 1.90; 95% CI, 1.59-2.27). CONCLUSIONS The use of GI prokinetics was significantly associated with higher occurrences of parkinsonism, necessitating close consideration when using GI prokinetics.
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Affiliation(s)
- Eunji Kim
- Department of Pharmacy, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Siin Kim
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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2
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Wang K, Alan J, Page A, Percival M, Etherton‐Beer C. Medication use to manage comorbidities in people with dementia: a systematic review. Pharmacy Practice and Res 2022. [DOI: 10.1002/jppr.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kate Wang
- School of Health and Biomedical Sciences Royal Melbourne Institute of Technology Melbourne Australia
- Pharmacy Department Alfred Health Melbourne Australia
| | - Janine Alan
- Centre for Research in Aged Care Edith Cowan University Joondalup Australia
| | - Amy Page
- Pharmacy Department Alfred Health Melbourne Australia
- Centre for Medicine Use and Safety Monash University Parkville Australia
| | - Mia Percival
- Pharmacy Department Alfred Health Melbourne Australia
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Seto SL, Barra ME, Hamidi A, Sin JH, Devine LT. Efficacy and Safety of Immediate-Release Nifedipine in Critically Ill Patients. J Pharm Pract 2022; 36:614-619. [PMID: 35152786 DOI: 10.1177/08971900221074953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Immediate-release nifedipine (IRN) is a calcium channel blocker with potent vasodilatory and antihypertensive properties. Safety concerns led to a black box warning for increased risk of myocardial infarction, stroke, and arrhythmias. OBJECTIVE The aim of this study was to evaluate the safety and efficacy of IRN for acute blood pressure lowering in critically ill patients. METHODS A retrospective, single-center study was performed in critically ill patients who received at least one dose of IRN. The primary endpoint was the change in systolic blood pressure (SBP) measured at baseline and 1 hour after first administration of IRN. Secondary outcomes included clinically significant hypotension, defined as an absolute reduction in SBP ≥ 15% or vasopressor initiation within 1 hour after administration; incidence of arrhythmias, stroke, or myocardial injury; and time to transition off antihypertensive infusions. RESULTS IRN resulted in a median [interquartile range] SBP change of -10 [-21 to -1] mmHg between baseline 142 mmHg [124-155] and 1 h post-administration 127 mmHg [114-144]; P < .001. Twenty-seven percent of patients experienced clinically significant hypotension, with hypotension observed in 24% and vasopressors initiated in 4% of patients. Sixteen percent of patients experienced new-onset arrhythmia and 18% experienced myocardial injury following IRN during hospitalization. Median time to transition off intravenous (IV) continuous infusion antihypertensives was 8.5 [0-31.5] hours. CONCLUSION IRN led to a reduction in SBP which may have been associated with clinically significant hypotension and need for vasopressor support. Further studies with direct comparisons to alternatives are needed to determine the true association of adverse events with IRN.
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Affiliation(s)
- Stephanie L Seto
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Megan E Barra
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Arzo Hamidi
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan H Sin
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Lauren T Devine
- Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA
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Kalar I, Xu H, Secnik J, Schwertner E, Kramberger MG, Winblad B, von Euler M, Eriksdotter M, Garcia-Ptacek S. Calcium channel blockers, survival and ischaemic stroke in patients with dementia: a Swedish registry study. J Intern Med 2021; 289:508-522. [PMID: 32854138 PMCID: PMC8049076 DOI: 10.1111/joim.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of calcium channel blockers (CCB) on mortality and ischaemic stroke risk in dementia patients is understudied. OBJECTIVES To calculate the risk of death and ischaemic stroke in dementia patients treated with CCBs, considering individual agents and dose response. METHODS Longitudinal cohort study with 18 906 hypertensive dementia patients from the Swedish Dementia Registry (SveDem), 2008-2014. Other Swedish national registries contributed information on comorbidities, dispensed medication and outcomes. Individual CCB agents and cumulative defined daily doses (cDDD) were considered. RESULTS In patients with hypertension and dementia, nifedipine was associated with increased mortality risk (aHR 1.32; CI 1.01-1.73; P < 0.05) compared to non-CCB users. Patients diagnosed with Alzheimer's dementia (AD) or dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) taking amlodipine had lower mortality risk (aHR, 0.89; CI, 0.80-0.98; P < 0.05 and aHR 0.58; CI, 0.38-0.86; P < 0.01, respectively), than those taking other CCBs. Amlodipine was associated with lower stroke risk in patients with Alzheimer's dementia compared to other CCBs (aHR 0.63; CI, 0.44-0.89; P < 0.05). Sensitivity analyses with propensity score-matched cohorts repeated the results for nifedipine (aHR 1.35; 95% CI, 1.02-1.78; P < 0.05) and amlodipine in AD (aHR, 0.87; CI, 0.78-0.97; P < 0.05) and DLB-PDD (aHR, 0.56, 95%CI, 0.37-0.85; P < 0.05). CONCLUSION Amlodipine was associated with reduced mortality risk in dementia patients diagnosed with AD and DLB-PDD. AD patients using amlodipine had a lower risk of ischaemic stroke compared to other CCB users.
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Affiliation(s)
- I Kalar
- From the, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - H Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - J Secnik
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - E Schwertner
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - M G Kramberger
- From the, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - B Winblad
- From the, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - M von Euler
- Department of Clinical Research and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm, Sweden
| | - M Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - S Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
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5
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Hsu CY, Huang LY, Saver JL, Wu YL, Lee JD, Chen PC, Lee M, Ovbiagele B. Oral short-acting antihypertensive medications and the occurrence of stroke: a nationwide case-crossover study. Hypertens Res 2019; 42:1794-1800. [PMID: 31300722 DOI: 10.1038/s41440-019-0300-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/19/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022]
Abstract
The purpose of the study was to clarify whether short-acting antihypertensives are associated with the occurrence of ischemic stroke and intracerebral hemorrhage (ICH). This was a retrospective case-crossover study using the Taiwan National Health Insurance Research Database. We identified all adult patients hospitalized with a primary diagnosis of ischemic stroke or ICH between January 2005 and December 2013. For each case, short-term and long-term exposure to short-acting antihypertensives, including nifedipine, labetalol and captopril, during the case vs. control periods were compared, and odd ratios (ORs) and 95% confidence intervals (CIs) for ischemic stroke or ICH were calculated with adjustment for confounders. Among 272785 ischemic stroke and 77798 ICH patients, the mean age was 77.8 ± 14.3 years and 70.8 ± 16.6 years, respectively. The short-term use of the three short-acting antihypertensives were all associated with an increase in the incidence of ischemic stroke (nifedipine: OR 4.51, 95% CIs 3.99-5.11; labetalol: OR 2.07; 95% CIs 1.71-2.51; captopril: OR 1.98, 95% CIs 1.72-2.29) and ICH (nifedipine: OR 2.98, 95% CIs 2.30-3.84; labetalol: OR 2.37; 95% CIs 1.66-3.39; captopril: OR 2.48; 95% CIs 1.69-3.63). The long-term use of short-acting nifedipine for 30 days was associated with a modest increase in the risk for ischemic stroke (OR 1.86; 95% CIs 1.42-2.45). Overall, the short-term use of short-acting antihypertensives is associated with a modest increase in the incidence of stroke, and short-acting nifedipine is linked to a substantial rise in the incidence of ischemic stroke. The long-term use of short-acting nifedipine was also related to an increased incidence of ischemic stroke. Physicians should be cautious of prescribing these short-acting antihypertensives.
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Affiliation(s)
- Chia-Yu Hsu
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ling-Ya Huang
- School of Pharmacy, National Taiwan University, Chiayi, Taiwan
| | - Jeffrey L Saver
- Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yi-Ling Wu
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taoyuan, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
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Gillman PK. A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths. J Neural Transm (Vienna) 2018; 125:1707-1717. [PMID: 30255284 DOI: 10.1007/s00702-018-1932-y] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/17/2018] [Indexed: 01/24/2023]
Abstract
This review appraises over 150 recent original papers reporting data that demonstrate the greatly reduced tyramine content of modern-day 'foods', about which the medical literature has a paucity of information. It discusses the cardiovascular pharmacology of tyramine and the characteristics, extent, risks, and treatment of the blood pressure increases that sometimes result from tyramine ingestion (the pressor response). In past decades, cheese was the only food associated with documented fatalities resulting from hypertension. Today, few foods contain problematically high tyramine levels, which is a result of changes in international food production techniques (especially the use of starter cultures), and hygiene regulations. Nowadays, even 'matured' cheeses are usually safe in healthy-sized portions. The mechanism by which tyramine may be produced in foods (by certain micro-organisms) is explained and hundreds of recent estimations of cheeses are reviewed. Numerous other previously inadequately documented foods are reviewed, including fish and soy sauces, salami-type sausages, dried meats, beers, wines, and various condiments. Evidence that the risk of harm from the pressor response has previously been overstated is reviewed, and the iatrogenic harms from hasty and aggressive treatment of hypertensive urgency are re-evaluated. Evidence now suggests that MAOIs are of comparable safety to many newer drugs and are straightforward to use. Previously held concerns about MAOIs are misplaced and some are of over-estimated consequence. The variability of pressor sensitivity to tyramine between individuals means that the knowledge and judgement of doctors, and some care, are still required.
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Lucenteforte E, Lombardi N, Vetrano DL, La Carpia D, Mitrova Z, Kirchmayer U, Corrao G, Lapi F, Mugelli A, Vannacci A. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators. Clin Interv Aging 2017; 12:1761-1778. [PMID: 29089750 PMCID: PMC5656349 DOI: 10.2147/cia.s137403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP) exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator “and”. The first regarded “prescriptions”, the second “adverse events”, the third “cardiovascular conditions”, and the last was planned to identify studies on “older people”. Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects aged ≥65 years; and observational effectiveness studies. The database searches produced 5,742 citations. After removing duplicates, titles and abstracts of 3,880 records were reviewed, and 374 full texts were retrieved that met inclusion criteria. Thus, 49 studies reporting 32 potential IP indicators were included in the study. IP indicators regarded mainly drug–drug interactions, cardio- and cerebrovascular risk, bleeding risk, and gastrointestinal risk; among them, only 19 included at least one study that showed significant results, triggering a potential warning for a specific drug or class of drugs in a specific context. This systematic review demonstrates that both cardiovascular and non-cardiovascular drugs increase the risk of adverse drug reactions in older adults with cardiovascular diseases.
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Affiliation(s)
- Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | | | | | | | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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8
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Bettiol A, Lucenteforte E, Vannacci A, Lombardi N, Onder G, Agabiti N, Vitale C, Trifirò G, Corrao G, Roberto G, Mugelli A, Chinellato A. Calcium Channel Blockers in Secondary Cardiovascular Prevention and Risk of Acute Events: Real-World Evidence from Nested Case-Control Studies on Italian Hypertensive Elderly. Clin Drug Investig 2017; 37:1165-1174. [PMID: 28975522 DOI: 10.1007/s40261-017-0576-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Antihypertensive treatment with calcium channel blockers (CCBs) is consolidated in clinical practice; however, different studies observed increased risks of acute events for short-acting CCBs. This study aimed to provide real-world evidence on risks of acute cardiovascular (CV) events, hospitalizations and mortality among users of different CCB classes in secondary CV prevention. METHODS Three case-control studies were nested in a cohort of Italian elderly hypertensive CV-compromised CCBs users. Cases were subjects with CV events (n = 25,204), all-cause hospitalizations (n = 19,237), or all-cause mortality (n = 17,996) during the follow-up. Up to four controls were matched for each case. Current or past exposition to CCBs at index date was defined based on molecule, formulation and daily doses of the last CCB delivery. The odds ratio (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. RESULTS Compared to past users, current CCB users had significant reductions in risks of CV events [OR 0.88 (95% CI: 0.84-0.91)], hospitalization [0.90 (0.88-0.93)] and mortality [0.48 (0.47-0.49)]. Current users of long-acting dihydropyridines (DHPs) had the lowest risk [OR 0.87 (0.84-0.90), 0.86 (0.83-0.90), 0.55 (0.54-0.56) for acute CV events, hospitalizations and mortality], whereas current users of short-acting CCBs had an increased risk of acute CV events [OR 1.77 (1.13-2.78) for short-acting DHPs; 1.19 (1.07-1.31) for short-acting non-DHPs] and hospitalizations [OR 1.84 (0.96-3.51) and 1.23 (1.08-1.42)]. CONCLUSIONS The already-existing warning on short-acting CCBs should be potentiated, addressing clinicians towards the choice of long-acting formulations.
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Affiliation(s)
- Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy.,Local Health Unit n.2 Marca Trevigiana, Veneto Region, Treviso, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy.
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences, and Orthopaedics, Catholic University of Medicine, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Roberto
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, viale Gaetano Pieraccini, 6, 50139, Florence, Italy
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Vondracek S, Scoular S, Patel T. Management of severe asymptomatic hypertension in the hospitalized patient. ACTA ACUST UNITED AC 2016; 10:974-984. [DOI: 10.1016/j.jash.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/06/2016] [Accepted: 10/30/2016] [Indexed: 11/30/2022]
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10
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Park SJ, Choi NK, Yang BR, Park KH, Woo SJ. Risk of stroke in retinal vein occlusion. Neurology 2015; 85:1578-84. [DOI: 10.1212/wnl.0000000000002085] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/02/2015] [Indexed: 11/15/2022] Open
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Park SJ, Choi NK, Yang BR, Park KH, Lee J, Jung SY, Woo SJ. Risk and Risk Periods for Stroke and Acute Myocardial Infarction in Patients with Central Retinal Artery Occlusion. Ophthalmology 2015; 122:2336-2343.e2. [PMID: 26298716 DOI: 10.1016/j.ophtha.2015.07.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/19/2015] [Accepted: 07/15/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the risk of stroke and acute myocardial infarction (AMI) in patients with incident central retinal artery occlusion (CRAO). DESIGN A self-controlled case series (SCCS) study. PARTICIPANTS Patients with incident CRAO from the entire Korean population of 48 million individuals. METHODS We used the Korean national claim database (2007-2011) for analyses. After identifying patients with incident CRAO, the relative incidence rate ratios (IRRs) for stroke and AMI in risk periods were measured in these patients using a SCCS method. MAIN OUTCOME MEASURES The IRRs of stroke and AMI by risk periods. RESULTS Of 1655 patients with incident CRAO in 2009-2010, 165 had stroke/AMI (ischemic stroke in 139, hemorrhagic stroke in 13, and AMI in 15) in the observation period spanning 365 days before and after the occurrence of CRAO. The IRR of stroke/AMI 1 to 30 days after CRAO occurrence significantly increased (14.0; 95% confidence interval [CI], 8.90-22.00); the IRR peaked during the 1 to 7 days after CRAO occurrence (44.51; 95% CI, 27.07-73.20), and the increased risk was present for the first 30 days. The IRR of stroke/AMI also significantly increased 1 to 30 days (6.82; 95% CI, 4.01-11.60) and 31 to 90 days (2.86; 95% CI, 1.66-4.93) before CRAO occurrence. Subanalysis for only ischemic stroke showed similar, magnified IRRs in the risk periods compared with all events. The IRRs were not significantly different between sexes or age groups (<65 vs. ≥65 years). CONCLUSIONS Patients with incident CRAO are at increased risk of ischemic stroke just after CRAO occurrence, and the risk is particularly increased during the first week immediately after the CRAO occurrence. The results suggest that patients with incident CRAO require immediate neurologic evaluation and preventive treatment to reduce mortality and morbidity.
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Shin JY, Choi NK, Lee J, Park MJ, Lee SH, Park BJ. A comparison of risperidone and haloperidol for the risk of ischemic stroke in the elderly: a propensity score-matched cohort analysis. J Psychopharmacol 2015; 29:903-9. [PMID: 25827642 DOI: 10.1177/0269881115578162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With an increase in antipsychotic use in the elderly, the safety profile of antipsychotics has been emphasized. Strong concerns have been raised about whether the risk of ischemic stroke differs between risperidone and haloperidol. This study compared the risk of ischemic stroke between elderly patients taking risperidone and haloperidol. METHOD We conducted a retrospective cohort study using the Korea Health Insurance Review and Assessment Service database, applying a propensity-matched analysis. The cohort consisted of elderly patients who were newly prescribed haloperidol or risperidone between January 1, 2006 and December 31, 2009. Patients with prior cerebrovascular diseases (ICD-10, I60-I69), transient ischemic attack (ICD-10, G45), or cerebral tumors (ICD-10, C31) during 365 days prior to the initiation date were excluded. The study subjects were selected by propensity score matching. The outcome was defined as the first hospitalization for ischemic stroke (ICD-10, I63). Cox regression models were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for ischemic stroke with haloperidol compared with risperidone use. RESULTS A total of 14,103 patients were included in the propensity-matched cohort for each drug. Overall, the incidence rate was higher for haloperidol users compared to the risperidone users (6.43 per 1000 person-years vs. 2.88 per 1000 person-years). A substantially increased risk was observed in haloperidol users (adjusted HR = 2.02, 95% CI, 1.12-3.62). CONCLUSIONS The evidence showed that haloperidol should be prescribed in the elderly with caution.
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Affiliation(s)
- Ju-Young Shin
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Ju Park
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Shin Haeng Lee
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Byung-Joo Park
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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Shin JY, Park MJ, Lee SH, Choi SH, Kim MH, Choi NK, Lee J, Park BJ. Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 2015; 351:h3517. [PMID: 26173947 PMCID: PMC4501372 DOI: 10.1136/bmj.h3517] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To define the risk of intracranial haemorrhage among patients treated with antidepressants and non-steroid anti-inflammatory drugs (NSAIDs), compared with the risk among those treated with antidepressants without NSAIDs. DESIGN Retrospective nationwide propensity score matched cohort study. SETTING Korean nationwide health insurance database between 1 January 2009 and 31 December 2013. PARTICIPANTS Patients who began receiving antidepressants for the first time (index date) without a history of having received a prescription for antidepressants during the preceding year. Patients who had been diagnosed as having cerebrovascular diseases within a year before the index date were excluded. MAIN OUTCOME MEASURE Time to first hospital admission with intracranial haemorrhage within 30 days after drug use. Matched Cox regression models were used to compare the risk of intracranial haemorrhage among patients who were treated with antidepressants with and without NSAIDs, after propensity score matching with a 1:1 ratio. RESULTS After propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 4,145,226 people. The 30 day risk of intracranial haemorrhage during the entire study period was higher for combined use of antidepressants and NSAIDs than for use of antidepressants without NSAIDs (hazard ratio 1.6, 95% confidence interval 1.32 to 1.85). No statistically meaningful differences were found in risk of intracranial haemorrhage between the antidepressant drug classes. CONCLUSIONS Combined use of antidepressants and NSAIDs was associated with an increased risk of intracranial haemorrhage within 30 days of initial combination.
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Affiliation(s)
- Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management, 110-750 Seoul, Korea
| | - Mi-Ju Park
- Korea Institute of Drug Safety and Risk Management, 110-750 Seoul, Korea
| | - Shin Haeng Lee
- Korea Institute of Drug Safety and Risk Management, 110-750 Seoul, Korea
| | - So-Hyun Choi
- Korea Institute of Drug Safety and Risk Management, 110-750 Seoul, Korea
| | - Mi-Hee Kim
- Korea Institute of Drug Safety and Risk Management, 110-750 Seoul, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University College of Medicine and Seoul National University Hospital, 110-799 Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University College of Medicine and Seoul National University Hospital, 110-799 Seoul, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, 110-799 Seoul, Korea
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Sleder AT, Kalus J, Lanfear DE. Cardiovascular Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics for the Clinical Practitioner. J Cardiovasc Pharmacol Ther 2015; 21:20-6. [PMID: 26054891 DOI: 10.1177/1074248415590196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/05/2015] [Indexed: 12/17/2022]
Abstract
Current clinical cardiovascular practice requires a clinician to have a strong foundation in multiple aspects of pharmacology. Modern cardiovascular regimens are complex, and optimal management, application of evolving guidelines, and adoption of new therapies build off a more basic understanding of pharmacokinetics and pharmacodynamics. In addition, it is likely time to add a third pillar into this discussion, the expanding field of pharmacogenomics referring to the genetic influences on drug response. This field has increasing applications in medicine and clearly holds significant promise for cardiovascular disease management. Awareness of pharmacogenomic advances and the fundamentals of pharmacokinetics and pharmacodynamics can help the clinician more easily deliver great care. Here we attempt to briefly summarize and simplify key concepts of pharmacokinetics, pharmacodynamics, and pharmacogenomics relevant to the cardiovascular disease practitioner.
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Affiliation(s)
- Anna T Sleder
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - James Kalus
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - David E Lanfear
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
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15
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Ponticelli C, Sala G, Glassock RJ. Drug management in the elderly adult with chronic kidney disease: a review for the primary care physician. Mayo Clin Proc 2015; 90:633-45. [PMID: 25771152 DOI: 10.1016/j.mayocp.2015.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/17/2015] [Accepted: 01/21/2015] [Indexed: 12/23/2022]
Abstract
With advancing age, the functional reserve of many organs tends to decrease. In particular, the lean body mass, the levels of serum albumin, the blood flow to the liver, and the glomerular filtration rate are reduced in elderly individuals and can be further impaired by the concomitant presence of acute or chronic kidney disease. Moreover, patients with kidney disease are often affected by comorbid processes and are prescribed multiple medications. The aging process also modifies some drug interactions, including the affinity of some drugs for their receptor, the number of receptors, and the cell responses upon receptor activation. Therefore, older patients with kidney disease are particularly susceptible to the risks of adverse drug reactions. Planning a pharmacological regimen in such patients is confounded by the paucity of information available on the pharmacokinetic and pharmacodynamic profiles of a large number of drugs commonly used in this group of patients. Finally, many aged patients suffer from unintentional poor compliance. In this review, the problems physicians face in designing safe and effective medication management in elderly individuals are discussed, paying attention to those more frequently used, which may be potentially harmful in patients with kidney disease. The risks of overdosing and underdosing are outlined, and some recommendations to reduce the risk of adverse drug reactions are provided. A review of the literature covering the field of drug management in older patients with kidney disease was performed by selecting those articles published between January 1, 1990, and December 1, 2014, using PubMed as a search engine with the keywords elderly, kidney disease, drugs, drug interaction, and renal function.
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Affiliation(s)
- Claudio Ponticelli
- Nephrology and Dialysis Unit, Humanitas Clinical Research Center, Rozzano, Milano, Italy.
| | - Gabriele Sala
- Nephrology and Dialysis Unit, Humanitas Clinical Research Center, Rozzano, Milano, Italy
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Chou CL, Chou CY, Hsu CC, Chou YC, Chen TJ, Chou LF. Old habits die hard: a nationwide utilization study of short-acting nifedipine in Taiwan. PLoS One 2014; 9:e91858. [PMID: 24637880 PMCID: PMC3956761 DOI: 10.1371/journal.pone.0091858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the nationwide trend of ambulatory prescriptions of short-acting nifedipine on a PRN (pro re nata) order over a fifteen-year period in Taiwan. METHODS The systematic sampling claims datasets (0.2% sampling ratio) of ambulatory care visits within Taiwan's National Health Insurance from 1997 to 2011 were analyzed. The prescriptions of short-acting capsule-form nifedipine on a PRN order were stratified by the patient's age, the prescribing physician's specialty, and the setting of healthcare facility for each year. RESULTS During the study period, 8,189,681 visits were analyzed. While the utilization rate of calcium channel blockers changed with time from 2.8% (13,767/489,636) in 1997 to 5.1% (31,349/614,719) in 2011, that of short-acting nifedipine were from 1.0% (n = 5,070) to 0.2% (n = 1,246). However, short-acting capsule-form nifedipine on a PRN order still existed (from 447 prescriptions in 1997 to 784 in 2011). More than one half of these PRN nifedipines were prescribed by the internists and to the elderly patients; almost four-fifths of PRN nifedipines were prescribed during non-emergent consultations. CONCLUSION The physicians in Taiwan still had the habit of prescribing short-acting nifedipines for PRN use. The reason for such practices and the impact on patients' health deserve attention.
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Affiliation(s)
- Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Yu Chou
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
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Affiliation(s)
- Sun-Young Jung
- Korea Institute of Drug Safety and Risk Management, Seoul, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Byung-Joo Park
- Korea Institute of Drug Safety and Risk Management, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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Lihite RJ, Lahkar M. Inappropriate drug use in hospitalized elderly patients of medicine and cardiology departments at a tertiary care hospital of Northeast India. Apollo Medicine 2013. [DOI: 10.1016/j.apme.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Consiglio GP, Burden AM, Maclure M, McCarthy L, Cadarette SM. Case-crossover study design in pharmacoepidemiology: systematic review and recommendations. Pharmacoepidemiol Drug Saf 2013; 22:1146-53. [DOI: 10.1002/pds.3508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/20/2013] [Accepted: 07/29/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Giulia P. Consiglio
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Andrea M. Burden
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver British Columbia Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario Canada
- Women's College Research Institute; Toronto Ontario Canada
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Onder G, Bonassi S, Abbatecola AM, Folino-Gallo P, Lapi F, Marchionni N, Pani L, Pecorelli S, Sancarlo D, Scuteri A, Trifirò G, Vitale C, Zuccaro SM, Bernabei R, Fini M. High Prevalence of Poor Quality Drug Prescribing in Older Individuals: A Nationwide Report From the Italian Medicines Agency (AIFA). ACTA ACUST UNITED AC 2013; 69:430-7. [DOI: 10.1093/gerona/glt118] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Wei YM, Xue ZK, Wang P, Zhao L. Formulation and pharmacokinetic evaluation of once-daily sustained-released system of nifedipine with solid dispersion and coating techniques. Arch Pharm Res 2013; 36:864-73. [DOI: 10.1007/s12272-013-0076-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/22/2013] [Indexed: 01/25/2023]
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Schubert I, Hein R, Abbas S, Thürmann P. The frequency of prescription of immediate-release nifedipine for elderly patients in Germany: utilization analysis of a substance on the PRISCUS list of potentially inappropriate medications. Dtsch Arztebl Int 2012; 109:215-9. [PMID: 22532813 DOI: 10.3238/arztebl.2012.0215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 01/17/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immediate-release nifedipine is on the PRISCUS list of drugs that should not be given to elderly patients. We studied the use of this calcium-channel blocker under real-life conditions. METHODS In 2009, we carried out a cross-sectional study based on the Statutory Health Insurance Sample AOK Hesse/KV Hesse with a sample size of 260 672 insurees. We used an anatomic-therapeutic-chemical classification (C08) to identify prescriptions for calcium-channel blockers. We determined from brand names and dosage forms whether nifedipine was prescribed in an immediate-release or sustained-release formulation. RESULTS Among insurees over age 65, the prevalence of treatment with immediate-release and sustained-release nifedipine was 0.9% and 1.0%, respectively. Immediate-release nifedipine was usually (75%) given in a single administration. 46% of patients receiving immediate-release nifedipine also received another calcium-channel blocker. Patients who received immediate-release nifedipine tended to take more cardiovascular drugs than those who received sustained-release nifedipine (6 or more cardiovascular drugs were taken by 30% and 16%, respectively). Among all medical diagnoses related to hypertension, two were significantly more common among patients taking immediate-release nifedipine than among those taking sustained-release nifedipine: hypertensive crisis (OR 4.26, 95% CI 2.45-7.40) and hypertensive heart disease (OR 1.82, 95% CI 1.04-3.19). CONCLUSION Our analysis demonstrates that immediate-release nifedipine is being prescribed to elderly patients in Germany, albeit mostly in a single administration. In view of the risks and the availability of alternative drugs, stricter adherence to the PRISCUS recommendations in this case should be stressed in continuing medical education.
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Affiliation(s)
- Ingrid Schubert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne.
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Thorpe CT, Lassila HC, O'Neil CK, Thorpe JM, Hanlon JT, Maher RL. Reconsideration of key articles regarding medication-related problems in older adults from 2011. Am J Geriatr Pharmacother 2012; 10:2-13. [PMID: 22330099 PMCID: PMC3378666 DOI: 10.1016/j.amjopharm.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Affiliation(s)
- Carolyn T Thorpe
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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