Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104283. doi: 10.1016/j.archger.2020.104283. Epub 2020 Nov 7.
To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools.
A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications.
36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines.
Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
根据明确的潜在不适当药物标准工具，确定潜在不适当药物与精神和行为障碍的药物相互作用。
2020 年 2 月进行了系统的范围审查。提取了研究特征、潜在不适当药物、药物相互作用、原理和提出的治疗管理。确定了在巴西和世界范围内商业化和潜在不适当药物标准的必要性。为最常被引用的潜在不适当药物提出了治疗管理建议。
确定了 36 种工具，其中包括 151 种药物相互作用，以及 132 种与认知障碍和痴呆症等六种精神和行为障碍相关的潜在不适当药物。认知障碍和痴呆症是报告最多的疾病，抗精神病药、抗胆碱能药和苯二氮䓬类药物是最常涉及药物相互作用的药物类别。尽管推荐使用利培酮和喹硫平，但当不可避免地需要使用抗精神病药时；治疗帕金森病的左旋多巴+卡比多巴；以及短半衰期和中半衰期苯二氮䓬类药物；证据质量需要进行评估。在本次审查中，强烈推荐睡眠卫生、减药、药物审查和不良反应的临床监测。此外，还可以考虑阿戈美拉汀、安非他酮、吗氯贝胺和褪黑素作为苯二氮䓬类药物的潜在更安全选择。
了解与潜在不适当药物使用相关的临床情况或风险发病机制，并对这些药物进行管理，以获得更安全的治疗等效物或非药物治疗替代方案，这对于患者安全至关重要。
