Table 2 Number of PIMs and those changed after pharmacist suggestion
Criteriaa | Detected (n = 432) | Suggested (n = 189) | Changed (n = 172) |
|---|---|---|---|
STOPP-v2 | 358 | 168 | 151 |
Drug indication criteria | |||
Any drug prescribed without an evidence-based clinical indication | 84 | 75 | 67 |
Any duplicate drug class prescription | 10 | 5 | 5 |
Cardiovascular System criteria | |||
Beta-blocker in combination with verapamil or diltiazem | 1 | 0 | 0 |
Thiazide diuretic with current significant hypokalaemia, hyponatraemia, hypercalcaemia or with a history of gout | 1 | 1 | 1 |
ACE inhibitors or Angiotensin Receptor Blockers in patients with hyperkalaemia | 7 | 3 | 3 |
Coagulation System criteria | |||
Aspirin, clopidogrel, dipyridamole, vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors with concurrent significant bleeding risk | 1 | 1 | 1 |
Ticlopidine in any circumstances | 4 | 3 | 3 |
NSAID and vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors in combination | 1 | 1 | 1 |
NSAID with concurrent antiplatelet agents without PPI prophylaxis | 1 | 0 | 0 |
Central Nervous System criteria | |||
Benzodiazepines for ≥4 weeksb | 108 | 20 | 16 |
Antipsychotics in those with parkinsonism or Lewy Body Disease | 3 | 1 | 1 |
Anticholinergics/antimuscarinics in patients with delirium or dementia | 5 | 4 | 3 |
First-generation antihistamines | 3 | 3 | 3 |
Renal System criteria | |||
NSAIDs if eGFR < 50 mL/min/1.73m2 | 5 | 3 | 3 |
Gastrointestinal System criteria | |||
PPI for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for > 8 weeks | 28 | 12 | 11 |
Drugs likely to cause constipation in patients with chronic constipation where non-constipating alternatives are appropriate | 3 | 1 | 0 |
Respiratory System criteria | |||
Benzodiazepines with acute or chronic respiratory failure | 1 | 0 | 0 |
Musculoskeletal System criteria | |||
NSAID with established hypertension or heart failure | 7 | 6 | 6 |
Long-term use of NSAID for symptom relief of osteoarthritis pain where paracetamol has not been tried | 1 | 1 | 1 |
Long-term corticosteroids as monotherapy for rheumatoid arthritis | 3 | 0 | 0 |
COX-2 selective NSAIDs with concurrent cardiovascular disease | 3 | 2 | 2 |
NSAID with concurrent corticosteroids without PPI prophylaxis | 1 | 0 | 0 |
Oral bisphosphonates in patients with a history of upper gastrointestinal disease | 1 | 1 | 1 |
Urogenital System criteria | |||
Antimuscarinic drugs for overactive bladder syndrome with concurrent dementia or chronic cognitive impairment or narrow-angle glaucoma, or chronic prostatism | 3 | 3 | 2 |
Endocrine System criteria | |||
Sulphonylureas with a long duration of action with type 2 diabetes mellitus | 16 | 4 | 4 |
Beta-blockers in diabetes mellitus with frequent hypoglycaemic episodes | 1 | 0 | 0 |
Drugs that predictably increase the risk of falls in older people | |||
Benzodiazepines | 23 | 8 | 7 |
Vasodilator drugs with persistent postural hypotension | 22 | 7 | 7 |
Hypnotic Z-drugs | 9 | 2 | 2 |
Antimuscarinic/anticholinergic drug burden | |||
Concomitant use of two or more drugs with antimuscarinic/anticholinergic properties | 2 | 1 | 1 |
STOPP-J | 74 | 21 | 21 |
Sulpiride | 3 | 1 | 1 |
H2 receptor antagonists | 32 | 12 | 12 |
Laxative magnesium oxide (decreased kidney function) | 23 | 8 | 8 |
α-glucosidase inhibitors | 15 | 0 | 0 |
SGLT2 inhibitors | 1 | 0 | 0 |