Potential Aspirin-Related Drug Interactions in the Elderly

Purpose: The purpose of this drug review was to explore the safety and efficacy of the newly approved benzodiazepine, remimazolam, in order to evaluate its place in therapy. Summary: Remimazolam has a faster onset of action and recovery time than midazolam when given as single IV doses. Additionally, it has no known CYP450 interactions that would contribute to drug-drug interactions. Patients with severe hepatic impairment may require dose titration as well as the elderly who should be closely monitored. Although remimazolam vials should be protected from light and must be reconstituted immediately before use, the reconstituted vial may be stored for later use at room temperature for up to 8 hours. Remimazolam is more expensive than current options used in practice, as such individual institutional formulary and provider preference will require review to see if its advantages are worth the additional cost and to determine its place in therapy. Conclusion: Remimazolam is a novel option when choosing a benzodiazepine for procedural sedation that has pharmacokinetic and pharmacodynamic advantages when compared to other commonly prescribed sedatives. Remimazolam has proved superior to midazolam when analyzing drug-drug interactions, onset, and time to alertness. Remimazolam also has a shorter elimination half-life and decreased volume of distribution when compared to midazolam.

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Review of Cimetidine Drug Interactions

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808301700205 ◽

1983 ◽

Vol 17 (2) ◽

pp. 110-120 ◽

Cited By ~ 38

Author(s):

Eugene M. Sorkin ◽

Diane L. Darvey

Keyword(s):

Blood Flow ◽

Drug Interactions ◽

Hepatic Blood Flow ◽

Hepatic Clearance ◽

Hepatic Metabolism ◽

Rapid Onset ◽

Related Drug ◽

Cytochrome P 450 ◽

Acid Labile ◽

Hepatic Cytochrome

The literature on cimetidine drug interactions has been thoroughly reviewed. Several different mechanisms have been proposed for cimetidine-related drug interactions. These mechanisms include: (1) impaired hepatic drug metabolism due to inhibition of hepatic microsomal enzymes, (2) reduced hepatic blood flow, resulting in decreased clearance of drugs that are highly extracted by the liver, (3) increased potential for myelosuppression when administered concurrently with other drugs capable of causing myelosuppression, and (4) altered bioavailability of acid-labile drugs. Cimetidine binds reversibly to the hepatic cytochrome P-450 and P-448 systems, resulting in decreased metabolism of drugs that undergo Phase I reactions (e.g., dealkylation and hydroxylation). In contrast, glucuronidation pathways are unaffected. The rapid onset and reversal of cimetidine's inhibition of hepatic metabolism indicates an effect on hepatic enzyme systems. Cimetidine also has been reported to decrease hepatic blood flow. Drugs that are highly extracted by the liver, such as propranolol, lidocaine, and morphine, may be postulated to have a decreased hepatic clearance. Cimetidine, through its effect on gastric pH, may increase the absorption of acid-labile drugs or may decrease the absorption of drugs. There have been reports of increased potential for myelosuppression when cimetidine is administered concurrently with drugs capable of causing bone marrow suppression. An understanding of the mechanisms involved in cimetidine drug interactions allows the clinician to prevent and predict these interactions.

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Drug Interactions and Reactions Update

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808201601205 ◽

1982 ◽

Vol 16 (12) ◽

pp. 925-929 ◽

Cited By ~ 6

Keyword(s):

Elderly Patient ◽

Drug Interactions ◽

The Elderly ◽

Salt Diet ◽

The Past ◽

Inadequate Knowledge ◽

Or Groups ◽

Low Salt ◽

Nonsteroidal Antiinflammatory Agents ◽

Extreme Care

Elderly patients take a large number of drugs, especially psychoactive agents, and polypharmacy seems to be the rule in acute hospital settings and in institutions alike. Knowledge about alteration in drug response, with aging, is still at a preliminary and investigational stage, and the problem is compounded by the fact that there are relatively few drugs for which a special geriatric dosage is recommended. It appears to be common practice to keep the elderly in “chemical strait jackets” in some institutions, with emphasis on the use of antipsychotic and sedative/hypnotic combinations. Use of these agents has reached such proportions in Britain and America that it has become necessary to warn that antipsychotic drugs should be used only to treat acute behavior disorders in such patients. The potential for drug-drug interactions in the elderly patient is, therefore, large, and, in the community, the most common categories of prescribed drugs taken by the elderly are psychotropics, diuretics, and antipyretic/analgesics. In addition, analgesics and laxatives are often taken as nonprescribed medicines. Poor compliance with medication instructions, hoarding of drugs, and inadequate knowledge of the purpose of medication are very common. The eventual sequel to these factors is hospitalization; diuretics, hypotensives, antiparkinsonian agents, and psychotropics carry the greatest risk of evoking serious adverse drug reactions. Some specific drugs or groups of drugs present peculiar problems to the aged patient; these agents are relatively few in number and include digoxin, hypotensives, diuretics, nonsteroidal antiinflammatory agents, benzodiazepines, phenothiazines, lithium, and other psychoactive drugs. Currently, lithium and the antirheumatoid agent benoxaprofen are causing much concern in regard to the elderly. With lithium, there are adverse effects suggestive of neurotoxicity, and interactions with concurrent neuroleptic and/or antidepressant therapy, diuretics, and low salt diet are involved. As for benoxaprofen, reports in the past few months have causally linked this drug with fatal cholestatic jaundice and other serious reactions; this drug has now been withdrawn from clinical use. Health professionals must use extreme care when treating an elderly patient with drugs.

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Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1809-98232016019.150062 ◽

2016 ◽

Vol 19 (3) ◽

pp. 533-544 ◽

Cited By ~ 1

Author(s):

Tiago Aparecido Maschio de Lima ◽

Adriana Antônia da Cruz Furini ◽

Tábata Salum Calille Atique ◽

Patricia Di Done ◽

Ricardo Luiz Dantas Machado ◽

...

Keyword(s):

Drug Interactions ◽

Prescription Drugs ◽

Adverse Reactions ◽

Drug Distribution ◽

The Elderly ◽

Elderly Persons ◽

Potential Drug ◽

Increased Risk ◽

Chi Squared ◽

Elderly Users

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

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Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database

Aging ◽

10.18632/aging.104018 ◽

2020 ◽

Vol 12 (19) ◽

pp. 19711-19739

Author(s):

Floor Swart ◽

Giampaolo Bianchi ◽

Jacopo Lenzi ◽

Marica Iommi ◽

Lorenzo Maestri ◽

...

Keyword(s):

Drug Interactions ◽

Real World ◽

The Elderly ◽

Administrative Database ◽

Real World Evidence

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Non-Steroidal Anti-Inflammatory Drugs: Usage and Co-prescription with Other Potentially Interacting Drugs in Elderly: a Cross-sectional Study

10.21203/rs.2.19183/v1 ◽

2019 ◽

Author(s):

Nuru Abdu ◽

Samuel Teweldemedhin ◽

Asmerom Mosazghi ◽

Luwam Asfaha ◽

Makda Teshale ◽

...

Keyword(s):

Adverse Effects ◽

Drug Interactions ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Protective Agents ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Introduction: Globally, non-steroidal anti-inflammatory drugs (NSAIDs) usage in the elderly with chronic pain has been reported as frequent. Though it is fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. Thus, the objective of the study was to assess the appropriateness of NSAIDs use and incidence of NSAIDs related potential interactions in elderly. Methods: A descriptive cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara between August 22 and September 29, 2018. The sampling design was two-stage random sampling and data was collected using a questionnaire, exit interview and by abstracting information from patients’ clinical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using SPSS. Results: A total of 285 elderly respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users, of which 74.6% were not prescribed prophylactic gastro-protective agents (GPAs). About 20% of the elderly were involved in polypharmacy and nearly all of the encountered potential NSAIDs related interactions (n=322) with prescribed drugs were moderate. Diabetes and hypertension were significantly associated with chronic NSAIDs use (OR=3, 95% CI: 1.54, 5.84; OR=9.99, 95% CI: 4.46, 22.38) and incidence of drug interactions (OR=3.95, 95%CI: 1.92, 8.13; OR=3.12, 95%CI: 1.81, 5.33) while diabetes and cardiac problem were significantly associated with incidence of polypharmacy (OR=4.33, 95% CI: 2.36, 7.96; OR=3.56, 95% CI: 1.05, 12.11). Conclusion: Though the overall reflection of prescription pattern of NSAIDs during the study period was almost satisfactory, gastro-protective agents were poorly prescribed as a prophylaxis.

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