Polypharmacy, the of equal authori...

Polypharmacy, the of equal authority use of multiple prescription or over-the-counter medications, is a growing point to be solved [i]or[/i] settled in the United States. Although polypharmacy may meet the eye in all age groups, it is a usual occurrence in elderly people. A number of studies demeanored during the past 10 years have revealed that patients age 65 and older use an average of sum of two units to six prescribed medications and the same to 3.4 non-prescribed medications onward a regular basis.(1) The puzzle of polypharmacy is so extensive that it was designated as the principal medication safety issue in the Healthy the public 2000 document.(2)

DEFINING POLYPHARMACY

There is no generally accepted definition of polypharmacy save that it indicates use of multiple medications by dint of a single patient. One researcher defines polypharmacy as excessive or unnecessary use of medications, and others consider it the prescription, administration, or use of more medications than are clinically indicated in a given patient.(3) For the aims of this article, polypharmacy is defined as coincident use of multiple medications by the agency of a single patient.

To date, little research has been convoyed to determine the safety and efficacy of combining multiple medications in a single patient. a certain quantity of researchers have suggested that research in pharmacology is not sophisticated enough at the not away time to examine the forces of multiple medications taken at the same time.(4) Others have referred to polypharmacy as an uncontroll experiment. They hint that a scientist in a laboratory would not combine eight to 10 different chemicals at random in a touchstone tube without first preparing for the consecutions Thus, when an elderly patient is prescribed eight to 10 medications concurrently it is impossible to predict the outcome(5)

Reasons for polypharmacy. A number of factors contribute to an somewhat advanced in life patient taking multiple medications concurrently With aging, the incidence of having at least united chronic disease or condition increases substantially. Eighty percent of individuals through the whole extent of the age of 65 have at least united chronic condition and 50% have more than one(6) With chronic conditions, a number of different medications may be used to treat the diseases, and all prescribed medications may be justified; however, in the age of specialty medical practice, there usually are several physicians treating common patient. Patients can have multiple health care providers prescribing multiple medications for several conditions with little, if any, coordination of care or medications. It is no surprise that the older population alone perishs more than 30% of all prescription medications.(7)

A related factor in the growth of polypharmacy is the health care provider who willingly writes multiple prescriptions because that is what the provider thinks the patient wants. Researchers have estimated that 75% of all visits to a physician ensue in a written prescription.(8) Little attention may be given to nonprescriptive meanss of treatment, and both the patient and the care provider may not think the visit was "successful" unles a prescription was written.

Adverse medication reactions. In general, somewhat old patients are prescribed more medications than younger patients, particularly when hospitalized. Use of multiple medications predisposes somewhat old patients to adverse drug reactions (ADRs). The number of medications a patient takes has been shown to be the chiefly consistent risk factor for ADRs.(9)

Researchers estimate that the potential for an ADR is

* 6% when patients take sum of two units medications,

* 50% when patients take five different medications, and

* 100% when patients take eight or more medications.(10)

Supporting the fact that ADRs are a universal problem in elderly patients is the statistic that 20% to 25% of hospital admissions for individuals older than age 65 are the arise of an ADR.(11) Table 1 lists categories of medications commonly prescribed to somewhat old patients. In particular, digoxin is single of the most widely used of all medications in somewhat old patients. Adverse reactions between digoxin and other medications flash on the mind with great frequency (Table 2)

Table 1

MEDICATIONS greatest in quantity COMMONLY ASSOCIATED WITH ADVERSE REACTIONS IN somewhat advanced in life PATIENTS(1)

* Psychotropic medications (particularly the benzodiazepines)

* Antihypertensives (including diuretics)

* Nonsteroidal anti-inflammatory medications

* Systemic steroids

* Theophylline

* Warfarin

* Cimetidine

* Digoxin

NOTE

(1) s Montamat, B Cusack, `Overcoming riddles with polypharmacy and drug misuse in the elderly" Clinics in Geriatric Medicine 8 (February 1992) 145-156

Table 2

MEDICATION INTERACTIONS WITH DIGOXIN(1)

* Amiodarone

* Antacids

* Choleslyromine

* Diltiazem

* Erythromycin

* Kaolin pectate

* Neomycin

* Para-aminosalicylic acid

* Quinidine

* Spironolactone

* Sulfasalazine

* Tetracycline

* Triamterene

* Verapamil

NOTE

(1) J Lindenfeld, "Congestive heart failure," in Geriatric Medicine, ed R Schrier (Philadelphia: Sounders, 1990) 261; A Swonger P Burbank, put drugs into Therapy in the Elderly (Boston: Jone & Bartlett, 1995) 220-225