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Polypharmacy Program - Drug-Disease Interactions
Medication Appropriateness Evaluation (MAE) tool
Drug-disease interactions (regardless of patient age)
Condition
Interacting Drug(s)
Potential Complication(s)
Recommendation(s)
CHF
Most calcium
channel blockers
(CCBs) (except
amlodipine)
CCBs with negative inotropic
effects can worsen CHF in patients
with reduced ejection fraction.1
• Most CCBs should be avoided
whenever possible in patients
with heart failure, even when
used for the treatment of angina
or hypertension.1
• Amlodipine is the only CCB to
not adversely affect survival in
CHF patients.1
CHF
Class I/III
antiarrhythmics
• These drugs are known to
adversely affect the clinical status
of patients with current or prior
symptoms of heart failure and
reduced LVEF.1
• Nearly all antiarrhythmics have
negative inotropic effects. The
risk of serious arrhythmia is
increased in CHF patients.1
• These antiarrhythmics are not
recommended in CHF patients
for the prevention of ventricular
arrhythmias.1
• May consider amiodarone or
dofetilide for patients with
symptomatic arrhythmias.1
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
OptumRx | optumrx.com
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
CHF
Non-steroidal
anti-inflammatory
drugs (NSAIDs)
• NSAIDs are known to adversely
affect the clinical status of patients
with current or prior symptoms of
heart failure and reduced LVEF.1
NSAIDs should be used with
caution or avoided in the CHF
population when possible.1
• NSAIDs cause a blunted response
to exogenous diuretics and
may increase systemic vascular
resistance.1
CHF
Thiazolidinediones
(e.g., pioglitazone,
rosiglitazone)
Fluid retention may occur with
thiazolidinediones. This may lead to
or exacerbate heart failure. The risk
is increased in patients concurrently
taking insulin.1
• Boxed warning:
Thiazolidinediones are
contraindicated in patients with
NYHA functional class III-IV CHF.
They should be used cautiously in
any CHF class.1
• Patient should be monitored for
new or increased CHF symptoms.1
CHF
metformin
Patients with unstable or
acute CHF who are at risk of
hypoperfusion and hypoxia are at
increased risk of lactic acidosis.2
• Due to the risk of developing
lactic acidosis, metformin should
be avoided in hospitalized patients
or those with unstable CHF.3
• Metformin may be used in
patients with stable CHF if renal
function is normal.3
CHF
cilostazol
•C
ilostazol and several of its
metabolites are inhibitors of
phosphodiesterase III, resulting
in ventricular tachycardia and
premature ventricular complexes.5
Contraindication: Cilostazol is
contraindicated in patients with
CHF of any severity.4 Avoid use in
this population.
• Other drugs that inhibit
phosphodiesterase III have
caused death in patients with
class III-IV CHF.5
History of
MI
NSAIDs
• NSAIDs may increase the risk of
cardiovascular thrombotic events,
such as MI and stroke. Patients
who have had a prior MI may be
at an increased risk.18
Consider alternative therapies if
clinically appropriate or prescribing
the lowest effective NSAID dose for
the shortest duration possible to
minimize the risk.18
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
2 OptumRx | optumrx.com
Asthma or
COPD
Non-selective
beta-blockers
(e.g., propranolol)
Non-selective beta-blockers may
cause bronchoconstriction by
counteracting the bronchodilation
produced by catecholamine
stimulation of beta-2 receptors.4,7
• Contraindication: Most
non-selective beta-blockers are
contraindicated or should be
avoided in patients with bronchial
asthma, bronchospasm, or COPD.2,7
• Cardioselective beta-blockers
(e.g., atenolol, metoprolol) or
another class of antihypertensives
(e.g., diuretics, angiotensinconverting enzyme inhibitors,
angiotensin II receptor blockers)
may be used cautiously.7,8
Parkinson’s
disease
metoclopramide
Metoclopramide has
antidopaminergic effects and
may exacerbate Parkinsonianlike symptoms, such as akinesia,
tremors and cogwheel rigidity.5,6,9
Metoclopramide should be used
with caution in patients with
Parkinson’s disease.2
Seizure or
epilepsy
bupropion
Bupropion may lower the seizure
threshold. The incidence of seizures
increases at higher dosages.5,6
• Contraindication: Bupropion is
contraindicated in patients with
a seizure disorder and should
be used with extreme caution in
patients with a history of seizures
or those with other predisposing
factors for seizures.4
• Consider antidepressants with
lower risk for seizure, such
as mirtazapine, trazodone,
nefazodone and SSRIs
(e.g., fluoxetine), as well as other
alternatives for smoking cessation
and/or weight loss if clinically
appropriate.4,5
BPH
atropinecontaining drugs
benztropine
mesylate
dicyclomine
hyoscyamine
oxybutynin
Select antimuscarinics with highly
anticholinergic properties may
aggravate BPH symptoms and/or
lead to urinary retention.5,6,10
• Highly anticholinergic medications
are not recommended for use in
patients with BPH.
• Topical oxybutynin (transdermal
patch, topical gel) have less
anticholinergic effects than oral
formulations although caution
is still advised when used in BPH
patients.4,5
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
3
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
BPH
amitriptyline
clomipramine
doxepin
imipramine
trimipramine
BPH
chlorpromazine
perphenazine
thioridazine
trifluoperazine
BPH
hydroxyzine
meclizine
Select TCAs have highly
anticholinergic properties.11
Their use in patients with BPH may
aggravate BPH symptoms and/or
lead to urinary retention.5,9
• Highly anticholinergic medications
are not recommended for use in
patients with BPH.
Phenothiazines with highly
anticholinergic properties may
aggravate BPH symptoms and/or
lead to urinary retention.5,6,10
Highly anticholinergic medications
are not recommended for use in
patients with BPH.
Antihistamines with highly
anticholinergic properties may
aggravate BPH symptoms and/or
lead to urinary retention.5,6,10
• Highly anticholinergic medications
are not recommended for use in
patients with BPH.
• Alternative antidepressant
drugs with less anticholinergic
activity include trazodone,
nefazodone and the SSRIs (e.g.,
fluoxetine).4,5 Secondary amine
TCAs (nortriptyline, protriptyline,
desipramine) have the least
amount of anticholinergic activity
among the TCAs.11,12
• Consider antihistamines with less
anticholinergic activity, such as
loratadine and fexofenadine.4,5
BPH
loxapine
Antipsychotics with highly
anticholinergic properties may
aggravate BPH symptoms and/or
lead to urinary retention.5,6,10
Highly anticholinergic medications
are not recommended for use in
patients with BPH.
Gallbladder
disease
Fibric acid derivatives
Fibric acid derivatives may increase
cholesterol excretion into the
bile, thereby increasing the risk of
developing gallstones.4
• Contraindication: Fibric acid
derivatives are contraindicated
in patients with gallbladder
disease.4
• In patients with pre-existing
gallstones, consider the use of
other agents for the treatment
of hypertriglyceridemia.2
Gout
Thiazides and
thiazide-like diuretics
Thiazide diuretics decrease uric
acid excretion, thus increasing the
risk of precipitating gout attacks or
developing hyperuricemia in certain
patients.2,5
For patients with frequent gout
attacks, consider another class of
antihypertensives (e.g., angiotensinconverting enzyme inhibitors,
angiotensin II receptor blockers).2
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
4 OptumRx | optumrx.com
Glaucoma
(closedangle)
atropinecontaining drugs
benztropine
mesylate
dicyclomine
Select antimuscarinics with highly
anticholinergic properties may
lead to ocular hypertensive crisis
in patients with closed-angle
glaucoma.5,9,10,19
Highly anticholinergic medications
are not recommended for use
in patients with closed-angle
glaucoma.13,14
TCAs have highly anticholinergic
properties.11 Use in patients with
closed-angle glaucoma may lead
to ocular hypertensive crisis.5,9,19
• Highly anticholinergic
medications are not
recommended for use in patients
with closed-angle glaucoma.13,14
• Alternative antidepressant
drugs with less anticholinergic
activity include trazodone,
nefazodone and the SSRIs (e.g.,
fluoxetine).4,5 Secondary amine
TCAs (nortriptyline, protriptyline,
desipramine) have the least
amount of anticholinergic activity
among the TCAs.11,12
Phenothiazines with highly
anticholinergic properties may
lead to ocular hypertensive crisis
in patients with closed-angle
glaucoma.5,9,10,19
Highly anticholinergic medications
are not recommended for use
in patients with closed-angle
glaucoma.13,14
Antihistamines with highly
anticholinergic properties may
lead to ocular hypertensive crisis
in patients with closed-angle
glaucoma.5,9,10,19
• Highly anticholinergic
medications are not
recommended for use in patients
with closed-angle glaucoma.
fesoterodine
hyoscyamine
oxybutynin
tolterodine
trospium
Glaucoma
(closedangle)
amitriptyline
clomipramine
doxepin
imipramine
trimipramine
Glaucoma
(closedangle)
chlorpromazine
perphenazine
prochlorperazine
thioridazine
Glaucoma
(closedangle)
hydroxyzine
meclizine
• Consider antihistamines with less
anticholinergic activity, such as
loratadine and fexofenadine.4,5
Glaucoma
(closedangle)
loxapine
Antipsychotics with highly
anticholinergic properties may lead to
ocular hypertensive crisis in patients
with closed-angle glaucoma.5,10
Highly anticholinergic medications
are not recommended for use
in patients with closed-angle
glaucoma.13,14
Mechanical
heart valve
dabigatran
Dabigatran is associated with
increased thromboembolic events
(e.g., stroke, transient ischemic
attack, myocardial infarction) and
bleeding in patients with mechanical
heart valves.4,5,20
Contraindication: Dabigatran is
contraindicated in patients with
mechanical heart valves.4,5,20
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
5
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
Drug-disease interactions in patients > 65 years of age
Condition
Interacting Drug
Potential Complication(s)
Recommendation(s)
Chronic
kidney
disease
COX-2 inhibitors
(e.g., celecoxib)
NSAIDs and COX-2 inhibitors may
lead to a reduction in renal blood
flow, suboptimal renal perfusion
and potential renal failure.5,15
Avoid use of NSAIDs or COX-2
inhibitors in elderly patients with
chronic kidney disease. Consider
alternative therapies if possible.
If an NSAID or COX-2 inhibitor must
be prescribed, use with caution and
monitor renal function.
Dementia
prochlorperazine
Phenothiazine antiemetic
medications with anticholinergic
properties have been associated
with cognitive impairment in
elderly patients. The concomitant
use of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
Use with caution in elderly
patients with history of dementia.
Consider alternate therapies
if clinically appropriate.
TCAs have been associated with
cognitive impairment in elderly
patients. The concomitant use
of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
• Use with caution in elderly
patients with history of dementia.
Consider alternate therapies if
clinically appropriate.
Antihistamines with anticholinergic
properties have been associated
with cognitive impairment in
elderly patients. The concomitant
use of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15
• Use with caution in elderly
patients with history of dementia.
Consider alternate therapies if
clinically appropriate.
NSAIDs
(except aspirin)
promethazine
Dementia
Dementia
Tricyclic
antidepressants
brompheniramine
carbinoxamine
chlorpheniramine
clemastine
cyproheptadine
dimenhydrinate
diphenhydramine
• Alternative antidepressant
drugs with less anticholinergic
activity include trazodone,
nefazodone and the SSRIs (e.g.,
fluoxetine).4,5 Secondary amine
TCAs (nortriptyline, protriptyline,
desipramine) have the least
amount of anticholinergic activity
among the TCAs.11,12
• Consider antihistamines with less
anticholinergic activity, such as
cetirizine and fexofenadine.4,5
hydroxyzine
loratadine
meclizine
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
6 OptumRx | optumrx.com
Dementia
benztropine
trihexyphenidyl
Dementia
atropinecontaining drugs
belladonna
dicyclomine
homatropine
hyoscyaminecontaining drugs
Antiparkinson medications with
anticholinergic properties have been
associated with cognitive impairment
in elderly patients. The concomitant
use of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
Antispasmodic medications with
anticholinergic properties have been
associated with cognitive impairment
in elderly patients. The concomitant
use of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
Urinary antispasmodic medications
with anticholinergic properties
have been associated with
cognitive impairment in elderly
patients. The concomitant use
of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
• Use with caution in elderly
patients with history of dementia.
Consider alternate therapies if
clinically appropriate.
Skeletal muscle relaxants with
anticholinergic properties have been
associated with cognitive impairment
in elderly patients. The concomitant
use of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15,16
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
Histamine H2-receptor antagonists
have been associated with
cognitive impairment in elderly
patients and may exacerbate
dementia5,6,15,17
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
propantheline
scopolamine
Dementia
darifenacin
fesoterodine
flavoxate
oxybutynin
solifenacin
tolterodine
trospium
Dementia
carisoprodol
cyclobenzaprine
orphenadrine
tizanidine
Dementia
cimetidine
famotidine
nizatidine
ranitidine
• Topical oxybutynin (transdermal
patch, topical gel) have less
anticholinergic effects than oral
formulations, although caution
is still advised for use in dementia
patients.4,5
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
7
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
Dementia
zolpidem
Select nonbenzodiazepine
hypnotics have been associated
with cognitive impairment in
elderly patients.5,6,15,17
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
Dementia
alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
estazolam
flurazepam
lorazepam
midazolam
oxazepam
quazepam
temazepam
triazolam
Benzodiazepines have been
associated with cognitive
impairment in elderly patients and
may exacerbate dementia 5,6,15,17
Use with caution in elderly patients
with history of dementia. Consider
alternate therapies if clinically
appropriate.
Dementia
aripiprazole
asenapine
brexpiprazole
chlorpromazine
clozapine
fluphenazine
haloperidol
iloperidone
• Antipsychotics with
anticholinergic properties
have been associated with
cognitive impairment in elderly
patients. The concomitant use
of anticholinergic drugs may
reduce the effectiveness of drugs
used to treat dementia, such as
cholinesterase inhibitors.5,6,15
• Boxed warning: Antipsychotics
are associated with increased
mortality when used in
patients with dementia-related
psychosis.16
loxapine
• Use with caution in elderly
patients with history of dementia.
Consider alternate therapies if
clinically appropriate.
lurasidone
molindone
olanzapine
paliperidone
perphenazine
pimozide
quetiapine
risperidone
thioridazine
thiothixene
trifluoperazine
ziprasidone
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
8 OptumRx | optumrx.com
History
of falls
alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
Benzodiazepines may increase
the risk of cognitive impairment,
delirium, dizziness and syncope.
This may increase the risk for falls in
susceptible individuals, especially in
patients with a history of falls.5,6,15,17
Use with caution in elderly patients
with history of falls. Caution
patients about the potential for
impaired motor function and
increased risk for falls.
Anticonvulsants may increase the
risk of confusion, disturbances of
coordination, drowsiness, dizziness
and syncope. This may increase
the risk for falls in susceptible
individuals, especially in patients
with a history of falls.5,6,15,17
Use with caution in elderly patients
with history of falls. Caution
patients about the potential for
impaired motor function and
increased risk for falls. For newonset epilepsy, newer agents are
preferred (e.g., lamotrigine and
levetiracetam). For neuropathic
pain, consider an SNRI, gabapentin,
pregabalin, topical capsaicin and
lidocaine patch.6
estazolam
flurazepam
lorazepam
midazolam
oxazepam
quazepam
temazepam
triazolam
History
of falls
carbamazepine
clobazam
divalproex
ethosuximide
ethotoin
ezogabine
felbamate
fosphenytoin
gabapentin
lacosamide
lamotrigine
levetiracetam
methsuximide
oxcarbazepine
phenobarbital
phenytoin
pregabalin
primidone
rufinamide
tiagabine
topiramate
valproic acid
vigabatrin
zonisamide
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
9
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
History
of falls
Selective serotonin
reuptake inhibitors
(SSRIs)
SSRIs may increase the risk of
ataxia, impaired psychomotor
functions, and syncope. This
may increase the risk for falls in
susceptible individuals, especially in
patients with a history of falls.5,6,15
Use with caution in elderly patients
with history of falls. Caution
patients about the potential for
impaired motor function and
increased risk for falls.
History
of falls
aripiprazole
asenapine
chlorpromazine
clozapine
fluphenazine
haloperidol
iloperidone
loxapine
lurasidone
molindone
olanzapine
paliperidone
perphenazine
pimozide
quetiapine
risperidone
thioridazine
thiothixene
trifluoperazine
ziprasidone
Select antipsychotic drugs may
cause orthostatic hypotension,
dizziness and syncope. This
may increase the risk for falls in
susceptible individuals, especially
in patients with a history of
falls.5,6,15,17
Use with caution in elderly
patients with history of falls.
Caution patients about the risk of
orthostatic hypotension, dizziness
and syncope.
History
of falls
prochlorperazine
Select antiemetics may cause
drowsiness, including CNS
depression and impaired motor
skills. They pose a risk for falls in
older patients, especially those with
a history of hip fractures.4,5,6,15
Use with caution in elderly patients
with history of falls. Consider
alternative therapies if clinically
appropriate.
promethazine
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
10 OptumRx | optumrx.com
History
of falls
Tricyclic
antidepressants
TCAs may impair motor skills
and pose a risk for falls in older
patients, especially those with a
history of hip fractures.4,5,6,15
• Use with caution in elderly
patients with a history of falls.
Consider antidepressants with
less anticholinergic activity, if
clinically appropriate.4,5,6,15
• Alternative antidepressant drugs
include SNRIs and bupropion.
Alternatives for neuropathic pain
include an SNRI, gabapentin,
pregabalin, topical capsaicin and
lidocaine patch.6
History
of falls
eszopiclone
zaleplon
zolpidem
Nonbenzodiazepine hypnotics can
impair motor function and pose an
increased risk for falls, especially
in older patients with a history of
falls.4,5,6,15
Consider alternative therapies
if clinically appropriate. If a
nonbenzodiazepine hypnotic must
be prescribed to elderly patients
with history of falls, caution them
about the potential for impaired
motor function and increased risk
for falls.
History
of falls
canagliflozin
Canagliflozin can increase the risk
of bone fractures and falls, and has
been linked to decreases in bone
mineral density of the hip and
lower spine.21,22
Consider factors that contribute
to fracture risk and alternative
therapies if clinically appropriate. If
canagliflozin must be prescribed to
elderly patients with history of falls,
caution them about the increased
risk of bone fractures and falls.
Ulcer/
Gastritis
flurbiprofen
indomethacin
ketoprofen
ketorolac
piroxicam
Nonsteroidal anti-inflammatory
drugs (NSAIDs), particularly those
with high gastrointestinal (GI)
toxicity, affect gastric acid secretion
leading to ulceration.23,24
It is recommended to discontinue
the high GI-risk NSAID, switch
to an alternate analgesic (e.g.
acetaminophen), or add a proton
pump inhibitor.23,24
Abbreviations: CHF — congestive heart failure. CCB — calcium channel blocker. LVEF — left ventricular ejection fraction. NSAID — non-steroidal anti-inflammatory drug.
NYHA — New York Heart Association. TCA — tricyclic antidepressant.. SSRI — selective serotonin reuptake inhibitor. SNRI — selective norepinephrine reuptake inhibitor.
COPD — chronic obstructive pulmonary disease. BPH — benign prostatic hyperplasia. COX-2 — cyclooxygenase-2. CNS — central nervous system.
MI – myocardial infarction.
11
Polypharmacy Program – Drug-Disease Interactions Medication Appropriateness Evaluation (MAE) tool
References
1. Y
ancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of
the ACCF/AHA Task Force on Practice Guidelines. Circulation. 2013;128:e240-e327
2. Micromedex Healthcare Series. http://www.micromedexsolutions.com/home/dispatch. Accessed December 4, 2015.
3. American Diabetes Association. Standards of medical care in diabetes - 2015. Diabetes Care. 2015;38(S1):S11-S93.
4. Facts & Comparisons [database online]. http://online.factsandcomparisons.com. Accessed December 4, 2015.
5. Clinical Pharmacology. http://www.clinicalpharmacology-ip.com/Default.aspx. December 4, 2015.
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