Graves T, Hanlon J T, Schmader K E, Landsman P B, Samsa G P, Pieper C F, Weinberger M
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
Arch Intern Med. 1997 Oct 27;157(19):2205-10.
Discontinuation of drug therapy is an important intervention in elderly outpatients receiving multiple medications, but it may be associated with adverse drug withdrawal events (ADWEs).
To determine the frequency, types, timing, severity, and factors associated with ADWEs after discontinuing medications in elderly outpatients.
One hundred twenty-four ambulatory elderly participants in 1-year health service intervention trial at the Durham Veterans Affairs General Medicine Clinic in Durham, NC, who stopped taking medications.
A geriatrician retrospectively reviewed computerized medication records and clinical charts to determine medications no longer being taken and adverse events in the subsequent 4-month period. Possible ADWEs, determined by using the Naranjo causality algorithm, were categorized by therapeutic class, organ system, and severity.
Of 238 drugs stopped, 62 (26%) resulted in 72 ADWEs among 38 patients. Cardiovascular (42%) and central nervous system (18%) drug classes were most frequently associated with ADWEs. The ADWEs most commonly involved the circulatory (51%) and central nervous (13%) systems, and 88% were attributed to exacerbations of underlying disease. Twenty-six ADWEs (36%) resulted in hospitalization or an emergency department or urgent care clinic visit. Only the number of medications stopped was associated with ADWE occurrence (adjusted odds ratio, 1.89; 95% confidence interval, 1.33-2.67).
Most medications can be stopped in elderly outpatients without an ADWE occurrence. However, when ADWEs occur they resulted in substantial health care utilization. Practitioners should strive to discontinue drug therapy in the elderly but be vigilant for disease recurrence.
在接受多种药物治疗的老年门诊患者中，停药是一项重要干预措施，但可能与药物撤药不良事件（ADWEs）相关。
确定老年门诊患者停药后ADWEs的发生频率、类型、时间、严重程度及相关因素。
北卡罗来纳州达勒姆市达勒姆退伍军人事务综合内科诊所1年健康服务干预试验中的124名非卧床老年参与者，他们停止了用药。
一名老年病医生回顾性审查计算机化的用药记录和临床图表，以确定不再服用的药物以及随后4个月内的不良事件。使用Naranjo因果关系算法确定的可能的ADWEs，按治疗类别、器官系统和严重程度进行分类。
在停用的238种药物中，62种（26%）导致38名患者发生72起ADWEs。心血管（42%）和中枢神经系统（18%）药物类别与ADWEs最常相关。ADWEs最常累及循环系统（51%）和中枢神经系统（13%），88%归因于基础疾病的加重。26起ADWEs（36%）导致住院或前往急诊科或紧急护理诊所就诊。只有停药数量与ADWEs的发生相关（调整后的优势比为1.89；95%置信区间为1.33 - 2.67）。
大多数药物在老年门诊患者中停用不会发生ADWEs。然而，当发生ADWEs时，会导致大量医疗资源的利用。从业者应努力在老年人中停用药物治疗，但要警惕疾病复发。
