Potentially harmful drug-drug interactions in the elderly: A review

Lisa E. Hines, John E Murphy

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

Background: Elderly patients are vulnerable to drug interactions because of age-related physiologic changes, an increased risk for disease associated with aging, and the consequent increase in medication use. Objective: The purpose of this narrative review was to describe findings from rigorously designed observational cohort and case-control studies that have assessed specific drug interactions in elderly patients. Methods: The PubMed and International Pharmaceutical Abstracts databases were searched for studies published in English over the past 10 years (December 2000-December 2010) using relevant Medical Subject Headings terms (aged; aged, 80 and over; and drug interactions) and search terms (drug interaction and elderly). Search strategies were saved and repeated through September 2011 to ensure that the most recent relevant published articles were identified. Additional articles were found using a search of review articles and reference lists of the identified studies. Studies were included if they were observational cohort or case-control studies that reported specific adverse drug interactions, included patients aged ≥65 years, and evaluated clinically meaningful end points. Studies were excluded if they used less rigorous observational designs, assessed pharmacokinetic/ pharmacodynamic properties, evaluated drug-nutrient or drug-disease interactions or interactions of drug combinations used for therapeutic benefit (eg, dual antiplatelet therapy), or had inconclusive evidence. Results: Seventeen studies met the inclusion criteria. Sixteen studies reported an elevated risk for hospitalization in older adults associated with adverse drug interactions. The drug interactions included: angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers and sulfamethoxazole/trimethoprim, benzodiazepines or zolpidem and interacting medications, calcium channel blockers and macrolide antibiotics, digoxin and macrolide antibiotics, lithium and loop diuretics or ACE inhibitors, phenytoin and sulfamethoxazole/trimethoprim, sulfonylureas and antimicrobial agents, theophylline and ciprofloxacin, and warfarin and antimicrobial agents or nonsteroidal anti-inflammatory drugs. One study reported the risk for breast cancer-related death as a function of paroxetine exposure among women treated with tamoxifen. Conclusions: Several population-based studies have reported significant harm associated drug interactions in elderly patients. Increased awareness and interventions aimed at reducing exposure and minimizing the risks associated with potentially harmful drug combinations are needed.

Original languageEnglish (US)
Pages (from-to)364-377
Number of pages14
JournalAmerican Journal of Geriatric Pharmacotherapy
Volume9
Issue number6
DOIs
StatePublished - Dec 2011

Fingerprint

Drug Interactions
Pharmaceutical Preparations
Angiotensin-Converting Enzyme Inhibitors
Macrolides
Sulfamethoxazole Drug Combination Trimethoprim
Drug Combinations
Anti-Infective Agents
Case-Control Studies
Potassium Sparing Diuretics
Pharmaceutical Databases
Medical Subject Headings
Anti-Bacterial Agents
Sodium Potassium Chloride Symporter Inhibitors
Paroxetine
Angiotensin Receptor Antagonists
Digoxin
Calcium Channel Blockers
Phenytoin
Warfarin
Tamoxifen

Keywords

  • drug interactions
  • elderly

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Potentially harmful drug-drug interactions in the elderly : A review. / Hines, Lisa E.; Murphy, John E.

In: American Journal of Geriatric Pharmacotherapy, Vol. 9, No. 6, 12.2011, p. 364-377.

Research output: Contribution to journalArticle

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