Klinische Pharmakologie, Private Universität Witten/Herdecke gGmbH, Wuppertal, Germany.
Dtsch Arztebl Int. 2010 Aug;107(31-32):543-51. doi: 10.3238/arztebl.2010.0543. Epub 2010 Aug 9.
Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly because they carry an increased risk of adverse drug events in this patient group. PIM lists from other countries are of limited usefulness in Germany because different drugs are on the market in each country and prescribing practices vary as well. Thus, a list of potentially inappropriate medications for the elderly was developed specifically for use in Germany.
A preliminary PIM list suitable for the German market was created on the basis of a selective literature search and a qualitative analysis of published international PIM lists. The final German PIM list was developed by means of a comprehensive, structured expert survey in two rounds (a so-called Delphi process).
83 drugs in a total of 18 drug classes were rated as potentially inappropriate for elderly patients. For 46 drugs, the experts came to no clear decision after the second Delphi round. For cases in which the administration of a PIM is clinically necessary, the final PRISCUS list contains recommendations for clinical practice, e.g. monitoring of laboratory values and dose adaptation. Therapeutic alternatives are also listed.
Potentially inappropriate medications carry the risk of causing adverse drug events in the elderly. A drawback of using a Delphi process to generate a PIM list, as was done for the new German list, is that little scientific evidence is currently available for the evaluation of active substances, potential therapeutic alternatives, and indicated monitoring procedures. Thus, the validity and practicability of the PRISCUS list remain to be demonstrated (and the same holds for PIM lists already published in other countries). It should be used as a component of an overall concept for geriatric pharmacotherapy in which polypharmacy and interacting medications are avoided, and doses are regularly re-evaluated.
某些药物被归类为老年人潜在不适当药物（PIM），因为它们在该患者群体中会增加不良药物事件的风险。其他国家的 PIM 清单在德国的用处有限，因为每个国家的市场上都有不同的药物，处方实践也有所不同。因此，专门为德国开发了一份老年人潜在不适当药物清单。
根据选择性文献搜索和对已发表的国际 PIM 清单的定性分析，初步制定了适合德国市场的 PIM 清单。通过两轮全面、结构化的专家调查（所谓的 Delphi 过程）制定了最终的德国 PIM 清单。
在总共 18 个药物类别中，有 83 种药物被评为老年人潜在不适当药物。对于 46 种药物，在第二轮 Delphi 之后，专家们没有做出明确的决定。对于需要临床使用 PIM 的情况，最终的 PRISCUS 清单包含了临床实践建议，例如监测实验室值和剂量调整。还列出了治疗替代方案。
潜在不适当的药物会增加老年人发生不良药物事件的风险。使用 Delphi 过程生成 PIM 清单，就像为新的德国清单所做的那样，存在的一个缺点是，目前可用于评估活性物质、潜在治疗替代方案和指示监测程序的科学证据有限。因此，PRISCUS 清单的有效性和实用性仍有待证明（其他国家已经发布的 PIM 清单也是如此）。它应作为老年药理学综合概念的一部分，其中应避免多药并用和相互作用的药物，并定期重新评估剂量。
