Beers-Fick criteria and drugs available through the Farmácia Dose Certa program
Keywords:
Aged, Pharmaceutical preparations, Drug prescriptions, Iatrogenic disease, Adverse effectsAbstract
CONTEXT AND OBJECTIVE: Farmácia Dose Certa is a program available in the State of São Paulo that is a national reference for providing drugs free of charge to the population. Elderly people receiving care deserve special attention regarding drugs that are appropriate for their age group. The objective was to assess the drugs in the program considered to be inappropriate for the elderly. DESIGN AND SETTING: Descriptive study evaluating free drug distribution in the State of São Paulo, Brazil. METHODS: Following the criteria proposed by Beers and Fick (drugs or drug classes that should be avoided among elderly people, independent of the diagnosis or clinical condition, because of the high risk of side effects and because other, safer drugs are available), the drugs in the Farmácia Dose Certa program that might be inappropriate for elderly people and the levels of evidence for each drug included were assessed. RESULTS: Among the available drugs, 10 (25.6%) were included within the Beers-Fick criteria. The drugs selected were: amitriptyline, cimetidine, diazepam, digoxin, fluoxetine, methyldopa, nifedipine, promethazine, thioridazine and ferrous sulfate. CONCLUSION: The list of drugs available within the Farmácia Dose Certa program may be considered appropriate for the general population, but not completely for the elderly population. Adjusting this list to the pharmacological aspects of aging will reduce the risks of drug interactions, falls, mental confusion and excessive sedation that result from drugs that are considered inappropriate for consumption by elderly people.
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Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2000: características da população e dos domicílios: resultados do universo. Rio de Janeiro: IBGE; 2000. Available from: http://www.ibge.gov. br/home/estatistica/populacao/censo2000/default.shtm. Accessed in 2010 (Sep 15).
Wong LLR, Carvalho JA. O rápido processo de envelhecimento populacional do Brasil: sérios desafios para as políticas públicas [The rapid process of aging in Brazil: serious challenges for public policies]. Rev Bras Estud Popul. 2006;23(1):5-26.
Flores LM, Mengue SS. Uso de medicamentos por idosos na região sul do Bra- sil [Drug use by the elderly in Southern Brazil]. Rev Saúde Pública = J Public Health. 2005;39(6):924-9.
Nóbrega OT, Karnikowski MGO. A terapia medicamentosa no idoso: cuidados na me- dicação [Pharmacotherapy in the elderly: precautions with medication]. Ciênc Saúde Coletiva. 2005;10(2):309-13.
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997;157(14):1531-6.
Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappro- priate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716-24.
Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Relação nacional de medicamentos essenciais. Rename. 6a ed. Brasília: Ministério da Saúde; 2009. Available from: http://portal.saude.gov.br/portal/arquivos/pdf/rename_2008.pdf. Accessed in 2010 (Sep 21).
Governo de São Paulo. Secretaria da Saúde. Programa Dose Certa. Lista de itens do Programa Dose Certa. Available from: http://www.saude.sp.gov.br/content/geral_aco- es_assistencia_farmaceutica_programa_dose_certa.mmp. Accessed in 2010 (Sep 21).
Gorzoni ML, Lima CAC. Análise dos parâmetros clínicos de idosos internados em en- fermaria de clínica médica [Analysis of clinical parameters of elderly inpatients in an internal medicine ward]. Rev Assoc Med Bras (1992). 1995;41(3):227-32.
Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the com- munity-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001;286(22):2823-9.
Beyth RJ, Shorr RI. Uso de medicamentos. In: Duthie EH, Katz PR, editores. Geriatria prática. 3a ed. Rio de Janeiro: Revinter; 2002. p. 37-46.
Ramos LR, Toniolo J, Cendoroglo MS, et al. Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results. Rev Saúde Pública = J Public Health. 1998;32(5):397-407.
Chaimowicz F, Ferreira TJXM, Miguel DFA. Use of psychoactive drugs and falls among older people living in a community in Brazil. Rev Saúde Pública = J Public Health. 2000;34(6):631-5.
Cohn CK, Shrivastava R, Mendels J, et al. Double-blind, multicenter comparison of ser- traline and amitriptyline in elderly depressed patients. J Clin Psychiatry. 1990;51 Suppl B:28-33.
Kyle CJ, Petersen HE, Overø KF. Comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients treated in general practice. Depress An- xiety. 1998;8(4):147-53.
Altamura AC, Percudani M, Guercetti G, Invernizzi G Efficacy and tolerability of fluoxetine in the elderly: a double-blind study versus amitryptiline. Int Clin Psychopharmacol. 1989;4 Suppl 1:103-6.
Stuppaeck CH, Geretsegger C, Whitworth AB, et al. A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients. J Clin Psychopharmacol. 1994;14(4):241-6.
Abdelfattah A, Rayet P, Carré C. Effets neuro-psychiatriques de la cimétidine: à propos d’un cas [Neuro-psychiatric effects of cimetidine: a case report]. Ann Med Psychol (Paris) 1993;151(6):475-7.
Basavaraju NG, Wolf-Klein G, Silverstone FA, Libow LS. Cimetidine-induced mental confu- sion in elderly. N Y State J Med. 1980;80(8):1287-8.
Kinnell HG, Webb A. Confusion associated with cimetidine. Br Med J. 1979;2(6202):1438.
Pomara N, Stanley B, Block R, et al. Increased sensitivity of the elderly to the central depressant effects of diazepam. J Clin Psychiatry. 1985;46(5):185-7.
Cumming RG, Miller JP, Kelsey JL, et al. Medications and multiple falls in elderly people: the St Louis OASIS study. Age Ageing. 1991;20(6):455-61.
Neutel CI, Hirdes JP, Maxwell CJ, Patten SB. New evidence on benzodiazepine use and falls: the time factor. Age Ageing. 1996;25(4):273-8.
Cusack B, Kelly J, O’Malley K, et al. Digoxin in the elderly: pharmacokinetic consequences of old age. Clin Pharmacol Ther. 1979;25(6):772-6.
Miura T, Kojima R, Sugiura Y, et al. Effect of aging on the incidence of digoxin toxicity. Ann Pharmacother. 2000;34(4):427-32.
Rich MW, McSherry F, Williford WO, Yusuf S; Digitalis Investigation Group. Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: the DIG study. J Am Coll Cardiol. 2001;38(3):806-13.
Ferguson JM, Hill H. Pharmacokinetics of fluoxetine in elderly men and women. Geronto- logy. 2006;52(1):45-50.
Tollefson GD, Bosomworth JC, Heiligenstein JH, Potvin JH, Holman S. A double-blind, pla- cebo-controlled clinical trial of fluoxetine in geriatric patients with major depression. The Fluoxetine Collaborative Study Group. Int Psychogeriatr. 1995;7(1):89-104.
Schöne W, Ludwig M. A double-blind study of paroxetine compared with fluoxetine in ge- riatric patients with major depression. J Clin Psychopharmacol. 1993;13(6 Suppl 2):34S- 39S.
Newhouse PA, Krishnan KR, Doraiswamy PM, et al. A double-blind comparison of sertra- line and fluoxetine in depressed elderly outpatients. J Clin Psychiatry. 2000;61(8):559- 68.
McKinney WT Jr, Kane FJ Jr. Depression with the use of alpha-methyldopa. Am J Psychiatry. 1967;124(1):80-1.
Fullerton AG, Morton-Jenkins D. Methyldopa and depression. Br Med J. 1963;1(5329):538-9.
VandenBurg MJ, Cooper WD, Woollard ML, Currie WJ, Bowker CH. Reduced peripheral vas- cular symptoms in elderly patients treated with alpha-methyldopa--a comparison with propranolol. Eur J Clin Pharmacol. 1984;26(3):325-9.
Patten SB, Love EJ. Can drugs cause depression? A review of the evidence. J Psychiatry Neurosci. 1993;18(3):92-102.
Bulpitt CJ, Connor M, Schulte M, Fletcher AE. Bisoprolol and nifedipine retard in elderly hypertensive patients: effect on quality of life. J Hum Hypertens. 2000;14(3):205-12.
Robertson DR, Waller DG, Renwick AG, George CF. Age-related changes in the pharmacoki- netics and pharmacodynamics of nifedipine. Br J Clin Pharmacol. 1988;25(3):297-305.
Conlin PR, Elkins M, Liss C, et al. A study of losartan, alone or with hydrochlorothiazi-de vs nifedipine GITS in elderly patients with diastolic hypertension. J Hum Hypertens. 1998;12(10):693-9.
McClintock GH, LaReau RM, Watcharotone K, DeMaagd G. The initial examination of the efficacy of low-dose promethazine for the treatment of nausea and vomiting in the hospi- talized elderly. Geriatr Nurs. 2010;31(2):115-22.
Scott J, Pache D, Keane G, Buckle H, O’Brien N. Prolonged anticholinergic delirium follo- wing antihistamine overdose. Australas Psychiatry. 2007;15(3):242-4.
Rigo JC, Rigo JFO, Faria BC, Santos VM. Demência reversível e quedas associadas ao biperideno [Reversible dementia and falls associated with biperiden]. Rev Psiquiatr Clín (São Paulo). 2006;33(1):24-7.
Hamra A, Ribeiro MB, Miguel OF. Correlação entre fratura por queda em idosos e uso prévio de medicamentos [Correlation between fractures resulting from falls and previous drug use]. Acta Ortop Bras. 2007;15(3):143-5.
Hughes GR. The problems of using NSAIDs in the elderly. Scand J Rheumatol Suppl. 1991;91:19-25.
Veitch PC, Clifton-Bligh RJ. Long-acting sulfonylureas--long-acting hypoglycaemia. Med J Aust. 2004;180(2):84-5.
Shats V, Kozacov S. [Falls in the geriatric department: responsibility of the care-giver and the hospital]. Harefuah. 1995;128(11):690-3, 743.
Evans JG, Jarvis EH. Nitrazepam and the elderly. Br Med J. 1972;4(5838):487.
Thayssen P, Bjerre M, Kragh-Sørensen P, et al. Cardiovascular effect of imipramine and nortriptyline in elderly patients. Psychopharmacology (Berl). 1981;74(4):360-4.
Jeste DV, Lacro JP, Palmer B, et al. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry. 1999;156(2):309-11.
Tideiksaar R. Lithium therapy in the elderly. West J Med. 1978;129(2):147-8.
Fu AZ, Jiang JZ, Reeves JH, et al. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care. 2007;45(5):472-6.
Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home resi- dents. Arch Intern Med. 2005;165(1):68-74.
Laroche ML, Charmes JP, Bouthier F, Merle L. Inappropriate medications in the elderly. Clin Pharmacol Ther. 2009;85(1):94-7.