Burato Sofia, Leonardi Luca, Antonazzo Ippazio Cosimo, Raschi Emanuel, Ajolfi Chiara, Baraghini Manuela, Chiarello Antonella, Delmonte Valentina, Di Castri Lucio, Donati Monia, Fadda Antonella, Fedele Daniela, Ferretti Alessandra, Gabrielli Laura, Gobbi Silvia, Lughi Sereno, Mazzari Martina, Pieraccini Fabio, Renzetti Alessandro, Russi Elsa, Scanelli Chiara, Zanetti Barbara, Poluzzi Elisabetta
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Post Graduate School of Hospital Pharmacy, Department of Pharmacy, University of Pisa, Pisa, Italy.
Front Pharmacol. 2021 Feb 11;11:624888. doi: 10.3389/fphar.2020.624888. eCollection 2020.
We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants-anxiolytics (11.9%) ranked first, followed by antidepressants-aspirin (7.4%). In outpatients, ACE-inhibitors-non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers-α-blockers (2.4%). Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.
我们旨在评估艾米利亚-罗马涅地区老年患者中多重用药的患病率以及具有临床相关性的潜在药物相互作用（DDIs）。对门诊患者和养老院居民均进行了评估，采用的策略仅有部分重叠。基于文献评估和治疗替代方案的可得性，我们确定了190对潜在相互作用药物的清单。收集了2018年1月至6月艾米利亚-罗马涅九个地方卫生当局辖区内65岁以上患者的用药数据：社区居住者的数据从报销处方档案中提取，而养老院样本中的用药情况则在同一学期内的一个索引日从临床病历中记录。计算了多重用药（至少五种或至少十种同时使用的药物）的频率以及每种药物相互作用的频率。与不同的多重用药率（80%对16%）一致，养老院中至少接触一种相互作用的风险为53.7%，门诊患者中为26.4%。在药物相互作用中，养老院中抗抑郁药-抗焦虑药（11.9%）位居首位，其次是抗抑郁药-阿司匹林（7.4%）。在门诊患者中，血管紧张素转换酶抑制剂-非甾体抗炎药（NSAIDs）达到7.2%，其次是钙通道阻滞剂-α受体阻滞剂（2.4%）。由于技术和临床原因，两种情况下的多重用药和药物相互作用风险存在很大差异。为了减少苯二氮䓬类药物、NSAIDs、抗抑郁药的使用以及相关的药物相互作用，应优先考虑：1）为老年门诊患者确定替代的疼痛缓解方案；2）在养老院实施失眠和焦虑的非药物管理。
