Drug safety among institutionalized elderly people: potential interactions

Cavalcante, Maria Lígia Silva Nunes; Alcântara, Renata Kelly Lopes de; Oliveira, Isabelly Costa Lima de; Aires, Samia Freitas; Girão, Ana Lívia Araújo; Carvalho, Rhanna Emanuela Fontenele Lima de

doi:10.1590/2177-9465-EAN-2019-0042

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Brasil

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REVIEW • Esc. Anna Nery 24 (1) • 2020 • https://doi.org/10.1590/2177-9465-EAN-2019-0042 copy

Drug safety among institutionalized elderly people: potential interactions^a a Article extracted from the Master dissertation “Safety in the drug administration process to elderly persons living in Long Stay Institution”. Author: Maria Lígia Silva Nunes Cavalcante. Orientadora: Rhanna Emanuela Fontenele Lima de Carvalho.

Seguridad medicamentosa en ajustes institucionalizados: potencial interacciones

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify the drug interactions among institutionalized elderly.

Method:

retrospective and documentary study with a quantitative approach developed in two Long Stay Institutions for Elderly, located in northeastern Brazil. Drug interactions were identified by using Drug-Reax® software from the Micromedex database, and they were classified by severity, start time, and documentation.

Result:

in the 286 analyzed prescriptions, 136 drug interactions were detected in both institutions, most of them classified as severe. The average number of drugs prescribed by the elderly was 4.5. In the analysis of Pearson's correlation, the number of drug interactions showed a statistically significant correlation with the time of institutionalization and with the amount of drugs administered on the day.

Conclusion and implications for practice:

the high consumption of drugs and serious drug interactions detected with significant clinical repercussions was evidenced in the study. Knowledge of these interactions is essential for the establishment of preventive safety measures in pharmacotherapy.

Keywords:
Drug Interactions; Health of the Elderly; Patient Safety

	Institution A N (53)		Institution B N (29)
Variables	f	%	f	%
Gender
Male	30	56.6	12	41.4
Female	23	43,3	17	58,6
Number of elderly with interaction
Yes	53	25.4	29	37.7
No	156	74.6	48	62.3
Number of identified interaction *	66	-	70	-
Number of drugs administered for 24h*
1-5	53	100	26	89.7
5-10	-	-	2	6.9
>10	-	-	1	3.4
Time of institutionalization*
Institution A: Average: 6 (±6.2) Minimum:1; Maximum: 33
Institution B: Average: 11 (±9.8) Minimum: 1; Maximum: 41
Age
Institution A: Average: 75(± 9) Minimum: 60; Maximum: 101
Institution B: Average: 76(± 10) Minimum: 61; Maximum: 99

	Institution A		Institution B
Variables	f	%	f	%
Severity
Serious	45	68.2	47	67.1
Moderate	20	30.3	22	31.5
Mild	1	1.5	1	1.5
Time from onset
Immediate	11	16.7	7	10.0
Late	17	25.8	23	32.9
Unspecified	38	57.6	40	57.1
Documentation
Poor	33	50,0	34	48,6
Good	26	39.4	33	47.1
Excellent	7	10.6	3	4.3
Clinical Management
Monitor clinical symptoms and laboratory parameters	37	56.1	16	22.9
The physician should adjust the dose	18	27.3	26	37.7
The physician should replace with another drug	9	13,6	25	35,7
The nurse should modify the time schedule	2	3,0	1	1,5
Unspecified	-	-	2	2,9

Drug - drug interaction		Clinical Effect	Severity	f(%)
Amlodipine	Simvastatin	Results in increase of the Simvastatin exposure and increased risk of myopathy, including rhabdomyolysis.	Serious	5(3.7)
Carbamazepine	Quetiapine	Increased exposure of Carbamazepine and the reduced risk of toxicity and effectiveness with Quetiapine. Ataxia, nausea, twitching and diplopia.	Serious	5(3.7)
Carbamazepine	Risperidone	Increased clearance of the Risperidone, loss of treatment efficacy.	Moderate	4(2.9)
Carvedilol	Metformin	It may result in hypoglycemia or hyperglycemia; reduction of hypoglycemia symptoms.	Moderate	4(2.9)
AAS	Metformin	The hypoglycemiant effect may increase with moderate doses of ASA	Serious	3(2.2)
Citalopram	Risperidone	Additive effects on the QT interval. They may result in increased risk of severe cardiac events.	Serious	3(2.2)
Hydroxyzin	Quetiapine	Additive effects on the QT interval. They may result in increased risk of severe cardiac events.	Serious	3(2.2)
Quetiapine	Risperidone	Additive effects on the QT interval. They may result in increased risk severe cardiac events.	Serious	3(2.2)
Quetiapine	Trazodone	Additive effects on the QT interval. They may result in increased risk of severe cardiac events.	Serious	3(2.2)
AAS	Valproic Acid	Increased plasmatic concentration of Valproic Acid.	Serious	2(1.5)
Valproic Acid	Risperidone	Increase of the plasmatic concentration of Valproic Acid.	Serious	2(1.5)
Atenolol	Metformin	The concomitant use of antidiabetic agents and beta-blockers can result in hypoglycemia or hyperglycemia; Reduction of hypoglycemia symptoms	Moderate	2(1.5)
Carbamazepine	Phenobarbital	Reduced Carbamazepine efficiency.	Moderate	2(1.5)
	Haloperidol	Reduced plasma concentration of Haloperidol.	Moderate	2(1.5)
	Zolpidem	Increased clearance of Zolpidem.	Serious	2(1.5)
Carbolithium	Phenergan	The concomitant use causes weakness, dyskinesia, increased extrapyramidal symptoms, encephalopathy and brain damages.	Serious	2(1.5)
	Neozine	Weakness, dyskinesia, increased extrapyramidal symptoms, encephalopathy, and brain damages.	Serious	2(1.5)
	Haldol	The concomitant use causes weakness, dyskinesia, increased extrapyramidal symptoms, encephalopathy and brain damages.	Serious	2(1.5)
Chlorpromazine	Quetiapine	Additive effects on the QT interval. They can result in increased risk of serious cardiac events.	Serious	2(1.5)
Digoxin	Furosemide	Result in toxicity of the digoxin (nauseas and vomiting, cardiac arrythmias).	Moderate	2(1.5)
Escitalopram	Haldol	Additive effects on the QT interval. They can result in increased risk of serious cardiac events.	Serious	2(1.5)
Escitalopram	Risperidone	Additive effects on the QT interval. They can result in increased risk of serious cardiac events.	Serious	2(1.5)
HCTZ	Enalapril	Reduction on blood pressure	Moderate	2(1.5)

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[1] Corresponding author: Maria Lígia Silva Nunes Cavalcante. E-mail: mlsnc14@gmail.com.