No abstract available.
Anticonvulsants* ; Drug Therapy* ; Polypharmacy*

Background: Polypharmacy has been linked to multiple undesirable effects notably medication, non-compliance and adverse drug reactions. Objective: This case-control study aimed to determine the association between polypharmacy and dementia among Filipino elderly patients in a tertiary care hospital in Metro Manila, Philippines. Methods: The average daily use of medications was compared between cases and controls composed of admitted Filipino elderly patients with and without dementia, respectively, while controlling for co-morbidities and sociodemographic factors. Data collection was accomplished by obtaining relevant information from medical records. These underwent descriptive statistical analysis, chi-square test, and logistic regression. The odds ratio between dementia and polypharmacy was ultimately determined, among other variables. Results: The incidence of polypharmacy is 12.6% greater in those with diagnosed dementia vis-à-vis those without. Although multivariate logistic regression analysis showed that the odds ratio of dementia was 1.474 (95% CI 0.834–2.604) for those considered to experience polypharmacy compared to patients using four or less drugs, none of the variables identified, including polypharmacy, have p-values of less than 0.05. Conclusion The risk of developing dementia does not have a statistically significant association with the number of regularly administered medications in the Filipino elderly. Other variables also revealed no significant correlation on both bivariate and multivariate analyses. This may be the first study to report such an absence of association, particularly in the Philippines, and thus calls for further research and investigation on this subject.
Polypharmacy ; Dementia ; Case-Control Studies

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.
Antipsychotic Agents ; Humans ; Inpatients ; Polypharmacy ; Prescriptions ; Schizophrenia

Background: Quality of Life (QoL) is an indicator of an elderly patient’s health status in achieving optimum care. However, no available local studies focused on QoL in elderly patients with polypharmacy. Better knowledge on this may help healthcare practitioners design and modify interventions that will suit elderly patients’ needs to improve both care and well-being. This study examined the QoL of elderly patients with polypharmacy and evaluated its relationship with demographic and clinical profile. Methods: A descriptive cross-sectional study was done among 333 elderly patients with polypharmacy seen at Region 1 Medical Center-Family and Community Medicine Out-Patient Department (R1MC-FCM OPD) from January to June 2019 using a self-administered EuroQoL-5 Dimension 5-Level (EQ-5D-5L) questionnaire to elicit the domains of QoL. The following statistical tests were utilized: Frequency count and percentage for analyzing gathered data; Spearman’s rank correlation for determining correlation between ordinal and continuous variables; and Mann-Whitney U and Kruskal-Wallis H tests for comparison of mean ranks. All analyses were performed using SPSS version 25. Results: Majority of the respondents were 60-69 years old (59.5%), female (55.3%), married (65.5%), attained at least elementary level education (38%), diagnosed with two illnesses (53%), taking four medications (65.5%) with an average monthly income below Php 10,000.00 (82.6%). Most of the respondents reported “no problems” in all five dimensions of EQ-5D-5L; however, decrease in usual activities (49.8%), pain (49.5%), and mobility (39%) were noted to be the common problems. Lower EQ-5D index and EQ-Visual Analogue Scale (EQ-VAS) scores were observed among respondents aged 80-90 years old, attained at least elementary level education, with three diagnosed illnesses, taking more than four medications, suffering mild cognitive impairment, partially dependent on activities in daily living, and mildly depressed (p <0.05). Conclusion The quality of life was reduced in the ageing population with low educational attainment, polypharmacy, multimorbidity, functional incapacity, cognitive impairment, and emotional problem.
Quality of Life ; Polypharmacy ; Outpatients ; Tertiary Care Centers

OBJECTIVE: Although antipsychotic polypharmacy is widely used in the pharmacotherapy of schizophrenia, its effectiveness is controversial. In particular, clinicians tend to avoid switching to monotherapy in patients who have been prescribed polypharmacy. In the present study, the authors investigate whether there is difference in time to discontinuation of antipsychotics between patients on previous monotherapy or polypharmacy. METHODS: Pooled analysis was conducted on two 24-week, multicenter, open-label, non-comparative studies that were originally designed to investigate the effectiveness of switching to paliperidone extended-release (ER) in patients with schizophrenia. Patients were divided into two groups according to previously prescribed antipsychotics, that is, to a polypharmacy group or a monotherapy group. The primary outcome measure was time to discontinuation of paliperidone ER. In addition, the authors sought to identify clinical variables that influence time to discontinuation. RESULTS: Before switching to paliperidone ER, 535 of 673 (79.5%) patients were prescribed antipsychotic monotherapy, and the remaining 138 (20.5%) patients were prescribed antipsychotic polypharmacy. No significant differences in time to discontinuation of paliperidone ER were observed between the polypharmacy and monotherapy groups. Personal and social performance scale score was the only factor found to influence time to discontinuation of paliperidone ER. No differences in psychopathology or adverse effects were found between the monotherapy and polypharmacy groups. CONCLUSION: Our results suggest that number of antipsychotics prescribed before switching to monotherapy does not influence clinical prognosis in patients with schizophrenia.
Antipsychotic Agents ; Drug Therapy ; Humans ; Outcome Assessment (Health Care) ; Polypharmacy* ; Prognosis ; Psychopathology ; Schizophrenia ; Treatment Outcome

OBJECTIVE: This study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals. METHODS: Data from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified. RESULTS: Of the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), beta-blockers (10.1%), and mood stabilizers (8.7%). CONCLUSION: The present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.
Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Hospitals, University ; Humans ; Korea ; Polypharmacy* ; Prescriptions* ; Psychotropic Drugs ; Retrospective Studies ; Schizophrenia*

The incidence of epilepsies and seizures is higher in the age group over 65-year-old than any other age group. The reduction of the dosages of antiepileptic drugs is recommended and the therapeutic effects can be expected even in the low dosage in the elderly. Because the daily activity is impaired and the health state is not good usually in the elderly, they are sensitive to the side effects of antiepileptic drugs. When using antiepileptic drugs in the elderly, the careful observation of possible side effects is essential. The elderly epileptic patients may have several concomitant diseases and it lead to have polypharmacy. The polypharmacy increase the risk of drug interactions. The dosage should be adjusted individually and the using drugs which are not necessary should be avoided. The clinical information about the use of antiepileptic drugs in the elderly is quite limited. In the elderly of the nursing home in the USA, phenytoin was the most frequently prescribed antiepileptic drug. However phenytoin is not the safest and most comfortable antiepileptic drug in the elderly. Generally, many aspects of the elderly including health state, concomitant diseases, concomitant medications, drug-interactions, side effects, and cost-effectiveness should be considered when choosing antiepileptic drugs in the elderly. The dosage of the selected antiepileptic drugs should be adjusted according to the clearance rate. The monitoring of the serum drug concentration may be helpful.
Aged ; Anticonvulsants ; Drug Interactions ; Epilepsy ; Humans ; Incidence ; Nursing Homes ; Phenytoin ; Polypharmacy ; Seizures

As a strategy for antipsychotic treatment of schizophrenia, monotherapy is clearly optimal when both effective and tolerated. When a patient fails to respond to an adequate dose of an antipsychotic, alternatives include switching, administering a higher dose (above the licensed dose), polypharmacy or clozapine. Clozapine is the only option with established efficacy, but is less manageable than other antipsychotics. We therefore reviewed other options, focusing on the treatment of acute-phase schizophrenia. According to recent evidence, an antipsychotic may be viewed as ineffective within 1-4 weeks in acute-phase practice, although some differences may exist among antipsychotics. Whether a switching strategy is effective might depend on the initial antipsychotic and which antipsychotic is switched to. As weak evidence points toward augmentation being superior to continuation of the initial antipsychotic, inclusion of augmentation arms in larger studies comparing strategies for early non-responders in the acute-phase is justified. With respect to high-doses, little evidence is available regarding acute-phase treatment, and the issue remains controversial. Although evidence for antipsychotic switching, augmentation, and high-doses has gradually been accumulating, more studies performed in real clinical practice with minimal bias are required to establish strategies for early non-response to an antipsychotic drug in the treatment of acute-phase schizophrenia.
Antipsychotic Agents* ; Arm ; Bias (Epidemiology) ; Clozapine ; Drug Substitution ; Humans ; Polypharmacy ; Schizophrenia*

As the population ages, more people are living with multiple medical conditions, and patients are suffering from functional decline or disabilities as part of multimorbidity. Multiple chronic diseases are the greatest challenge facing health-care systems, but we are still focused on individual disorders rather than multimorbidity. A new care model for these patients is required. First, we have to know that most clinical guidelines were developed in relation to single conditions, so following the guidelines without regard to a patient's multimorbidity should be avoided. Physicians should be encouraged to consider their patients as a whole person rather than focusing on the disease itself. Second, it is necessary to identify and listen to patients' priorities. Focusing on outcomes that come from a single-condition approach is the most important barrier to goal-oriented care. Third, comprehensive geriatric assessment and care can improve the functional outcome of older patients with multimorbidity. It is important to order the chaos of multiple chronic conditions and share the same therapeutic plan among doctors. Lastly, doctors must review patients' medication lists systematically before adding a new medication. Clearly, we should avoid prescription of potentially inappropriate medications and polypharmacy.
Chronic Disease ; Comorbidity ; Geriatric Assessment ; Humans ; Patient-Centered Care ; Polypharmacy ; Prescriptions

Older persons generally have greater susceptibility to infections than younger adults, probably because of the increased frequency of comorbidities and physiologic changes. There are many factors, both patient-related and treatment-related, which contribute to unique aspects of antimicrobial use in elderly persons that make prescribing complicated. Physiologic and pharmacokinetic changes associated with aging results in a higher risk of an adverse drug event and a harmful drug interaction, making antimicrobial dosing difficult. The risk of polypharmacy and more frequent adverse drug reactions in the elderly population justify a thorough consideration of the patient's true need for antimicrobial therapy. Given the increase in the elderly population and in the incidence of adverse drug reaction among elderly persons, further efforts should be made to optimize approach to management of infectious diseases in elderly persons.
Adult ; Aged ; Aging ; Anti-Bacterial Agents ; Communicable Diseases ; Comorbidity ; Drug Interactions ; Drug Toxicity ; Humans ; Incidence ; Polypharmacy