Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults

Abstract Objectives Alcohol and medication use are increasingly prevalent in the older population. Concurrent use of alcohol and alcohol-interactive (AI) medication can lead to significant adverse consequences. Methods Three reference works were used to create an explicit list of drug substances for which information about the interaction with alcohol was available in at least one of them. Additional information was extracted from the Summary of Product Characteristics (SPC). The first aim was to generate a list of 256 substances with standardized advice regarding the concurrent use of each drug with alcohol. The second aim was to observe the prevalence of potential drug–alcohol-interactions. The list was applied to a database containing information about alcohol and medication use of 1,016 community-dwelling older patients (≥70 years) with polypharmacy. Results About half of the sample population reported to consume alcohol at least once a week. Around 22% were classified as frequent drinkers (5–7 days/week) and 11% as heavier drinkers (>7 units/week). Ninety-three percent alcohol consumers in our sample took at least one chronic drug that potentially interacts with alcohol and 42% used at least one chronic drug for which alcohol use is considered contraindicated. Conclusions We developed an explicit list of potentially drug–alcohol-interactions in older adults, with standardized handling advice. We observed that prevalence of potential drug–alcohol-interactions is substantial in community-dwelling older patients with polypharmacy.

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Prevalence of simultaneous use of alcohol and prescription medication in older adults: findings from a cross-sectional survey (Health Survey for England 2013)

BMJ Open ◽

10.1136/bmjopen-2018-023730 ◽

2019 ◽

Vol 9 (6) ◽

pp. e023730 ◽

Cited By ~ 2

Author(s):

John Foster ◽

Swatee Patel

Keyword(s):

Older Adults ◽

Health Survey ◽

Prescription Drugs ◽

Prescription Medication ◽

Well Being ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Related Factors ◽

Cross Sectional ◽

Concurrent Use

ObjectivesTo investigate the concurrent use of ‘at-risk’ (AR) drinking (>10 units of alcohol per week) and prescription medications, while controlling for sociodemographic, and health-related factors, among older adults (aged 65–89 years).DesignCross-sectional survey.SettingData from Health Survey of England, 2013.InterventionsNone.ParticipantsGeneral population survey of 2169 adults aged 65–89 years.Primary outcome measuresAR drinking (>10 units per week). Secondary outcome was AR drinking defined as >14 units of alcohol per week limit (the cut-off used by the Department of Health for AT drinking).ResultsTwenty-seven per cent (n=568) of the sample were AR drinkers. Factors associated with alcohol consumption were gender, age, social class, marital status, rurality of dwelling, deprivation index, self-reported general health, cigarette smoking, body mass index, exercise level, health and well-being scores’ and number of prescription drugs. Logistic regression analysis showed that males were more likely to be AR drinkers (OR 3.44, 95% CI 2.59 to 4.57, p<0.0001) than females. Each year increase in age, lowered the probability of AR drinking by a factor of 0.95 (95% CI 0.93 to 0.98, p<0.0001). Using prescription drugs reduced AR drinking by a factor of 0.92 (95% CI 0.85 to 0.93, p=0.033), after controlling for age, sex and rurality of dwelling. No other predictors were significant. Similar results were obtained for AR drinking of >14units per week.ConclusionAR drinking is more likely in older men than women. The odds of AR drinking lessens, as individuals age, and using prescription drugs also reduces AR drinking.

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Interfering Medications in Older Adults on Thyroid Hormone Replacement: Who Is at Risk?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1694 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A831-A831

Author(s):

Rachel Beeson ◽

Antoinette B Coe ◽

David Reyes-Gastelum ◽

Megan R Haymart ◽

Maria Papaleontiou

Keyword(s):

Older Adults ◽

Thyroid Hormone ◽

Thyroid Function ◽

Hormone Replacement ◽

Patient Characteristics ◽

Population Based ◽

Thyroid Function Tests ◽

Thyroid Hormone Replacement ◽

Function Tests ◽

Concurrent Use

Abstract Background: Thyroid hormone prescriptions have steadily increased in the past few years with levothyroxine being one of the most frequently prescribed medications in the United States. Population-based studies have shown that older age is a significant predictor for thyroid hormone initiation, with use continuing long-term. Thyroid hormone management in older adults is complicated by the presence of comorbidities and polypharmacy, particularly due to medications that can interfere with thyroid function tests. However, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults and patient characteristics associated with this practice remain unknown. Methods: We conducted a population-based, retrospective cohort study of 538,137 thyroid hormone users aged ≥65 years from the Corporate Data Warehouse of the Veterans Health Administration (2004-2017). First, we described the prevalence of concurrent use of thyroid hormone and medications that commonly interfere with thyroid function tests (i.e., prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha, tamoxifen). Then, we performed a multivariable logistic regression analysis to determine patient characteristics associated with concurrent use of thyroid hormone and at least one interfering medication during the study period. Covariates included in the model were patient age, sex, race, ethnicity and number of comorbidities. Results: Overall, 170,261 (31.6%) of patients were on at least one interfering medication while on thyroid hormone during the study period (median follow up 56 months). Non-white race [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.15-1.21], compared to white race), Hispanic ethnicity (OR 1.11, 95% CI 1.08-1.14, compared to non-Hispanic), female sex (OR 1.12, 95% CI 1.08-1.15, compared to male sex), and presence of comorbidities (e.g. Charlson-Deyo Comorbidity Score ≥2, OR 2.47, 95% CI 2.43-2.52, compared to zero) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (e.g., ≥85 years, OR 0.47, 95% CI 0.46 - 0.48, compared to age 65-74 years) was less likely to be associated with concurrent use of thyroid hormone and interfering medications. Conclusions: Almost one-third of older adults on thyroid hormone were taking medications that have been known to interfere with thyroid function tests. Our study highlights the complexity of managing thyroid hormone replacement in older patients, many of whom are at risk for adverse effects in the context of polypharmacy and comorbidities.

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Detect Drug Interactions with Metronidazole

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47a33049 ◽

2021 ◽

pp. 597-604

Author(s):

Ibrahim Dighriri ◽

Ahmed Mobarki ◽

Naif Althomali ◽

Khalid Alqurashi ◽

Othman Daghriri ◽

...

Keyword(s):

Drug Interactions ◽

Qt Interval ◽

Clinical Care ◽

Cost Effective ◽

Interval Prolongation ◽

Treatment Regimens ◽

Risk Of Bleeding ◽

Qt Interval Prolongation ◽

Concurrent Use ◽

Effective Medication

Introduction: Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; nevertheless, it interacts with a wide variety of other medications. Some interactions with other medicines diminish its effectiveness, while others increase it. Aims: The study aims to detect and evaluate metronidazole interactions with other medicines at King Abdulaziz Specialist Hospital. Methodology: This retrospective study encompasses the review of 360 computerized prescriptions inside the outpatient clinic at King Abdulaziz Specialist Hospital in Saudi Arabia between March and September 2020 to detect and evaluate interactions among metronidazole and different medications. Results: Metronidazole interactions are mostly major or moderate. Metronidazole had the most common interactions with domperidone (15.83 %), famotidine (13.89 %), and ciprofloxacin (11.67 %). Metronidazole contains a nitroimidazole ring, which suppresses the metabolism in the liver of numerous medications, including those that may be metabolized by the CYP3A4 and/or CYP450 2C9 isoenzymes. The combination of metronidazole with phenytoin or phenobarbital can cause metronidazole elimination to be accelerated and phenytoin clearance to be reduced. Metronidazole may improve warfarin's anticoagulant effects, leading to a longer prothrombin time and a higher risk of bleeding. Concurrent use of metronidazole with alfuzosin, escitalopram, and ondansetron may raise the risks of QT-interval prolongation and arrhythmias. Conclusion: Most metronidazole drug interactions can be avoided by following excellent clinical care and clinical pharmacology concepts, such as avoiding complex treatment regimens, educating patients. and identifying patient risk factors. Furthermore, before prescribing and dispensing medicines, physicians and pharmacists should utilize drug-drug interactions checkers such as Micromedex and Lexicomp or a book such as Stockley's Drug Interactions.

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Prevalence of drug–herb and drug–supplement interactions in older adults: a cross-sectional survey

British Journal of General Practice ◽

10.3399/bjgp18x699101 ◽

2018 ◽

Vol 68 (675) ◽

pp. e711-e717 ◽

Cited By ~ 14

Author(s):

Taofikat B Agbabiaka ◽

Neil H Spencer ◽

Sabina Khanom ◽

Claire Goodman

Keyword(s):

Older Adults ◽

Drug Interactions ◽

Dietary Supplements ◽

Prescription Drugs ◽

Community Dwelling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Evening Primrose ◽

Supplement Use ◽

Concurrent Use

BackgroundPolypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults.AimTo establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions.Design and settingCross-sectional survey of older adults registered at two general practices in South East England.MethodA questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug.ResultsIn total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions.ConclusionGPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.

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Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review

Drugs & Aging ◽

10.1007/s40266-017-0501-7 ◽

2017 ◽

Vol 34 (12) ◽

pp. 891-905 ◽

Cited By ~ 27

Author(s):

Taofikat B. Agbabiaka ◽

Barbara Wider ◽

Leala K. Watson ◽

Claire Goodman

Keyword(s):

Systematic Review ◽

Older Adults ◽

Prescription Drugs ◽

Medicinal Products ◽

Herbal Medicinal Products ◽

Concurrent Use ◽

Herbal Medicinal

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Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe

Family Practice ◽

10.1093/fampra/cmaa062 ◽

2020 ◽

Vol 37 (6) ◽

pp. 793-800

Author(s):

Johnny T K Cheung ◽

Ruby Yu ◽

Jean Woo

Keyword(s):

Older Adults ◽

Hong Kong ◽

Pooled Analysis ◽

Community Dwelling ◽

Cardiometabolic Diseases ◽

Concurrent Use ◽

Stratified Analysis ◽

Community Dwelling Older Adults ◽

Additive Risks

Abstract Background Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). Objective To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases Methods We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1–2-year follow-up. We performed regression analyses to address the objective. Results Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with ‘multimorbidity alone’ [adjusted odds ratio (AOR) 1.10 and 1.26] and ‘polypharmacy alone’ (AOR 1.57 and 1.68). With ‘multimorbidity and ‘polypharmacy’ combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant. Conclusion Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.

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