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Alhussain K, Almuayli DI, Aldaej SM. Factors associated with the use of over-the-counter sleep aids containing diphenhydramine: A cross-sectional study in Saudi Arabia. Saudi Pharm J 2023; 31:101679. [PMID: 37448839 PMCID: PMC10336667 DOI: 10.1016/j.jsps.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Diphenhydramine, either alone or in combination with pain relievers, is one of the widely used over-the-counter sleep aids. However, few studies have evaluated the use of diphenhydramine-containing products, such as Panadol Night, in Saudi Arabia. Therefore, the objectives of this study were to assess the prevalence of Panadol Night use and to identify factors associated with its use in the Eastern Province of Saudi Arabia. Methods A cross-sectional study was conducted among adults aged 18 years or older in the Eastern Province of Saudi Arabia. Data were collected through an online self-administered questionnaire from 05 March 2022 to 20 March 2022. Chi-square tests and multivariable logistic regression models were used to examine the associations between Panadol Night use in the past month and independent variables. Results A total of 1244 adults participated in the survey. Approximately, 42.3% reported that they have used Panadol Night in their lifetime; 12.1% used Panadol Night in the past month. The majority of the Panadol Night users (62.4%) reported that their use was based on their family/friends' recommendations, while 23.6% used Panadol Night based on healthcare providers' recommendations. The multivariable logistic regression models showed that gender, health related fields, perceived safety and effectiveness of Panadol Night, a history of insomnia, trouble sleeping due to pain, and sleep quality were significantly associated with the use of Panadol Night in the past month. Conclusions Our findings indicated that adults' perceptions of the effectiveness and safety of Panadol Night were significantly associated with its use. Also, adults in non-health related fields were more likely to use Panadol Night compared to those in health related fields. This suggests the need for raising awareness about the appropriate use of Panadol Night. Community pharmacists can play an essential role in educating patients during the time of purchase.
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Affiliation(s)
- Khalid Alhussain
- Corresponding author at: Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia.
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Lehnbom EC, Berbakov ME, Hoffins EL, Moon J, Welch L, Chui MA. Elevating Safe Use of Over-The-Counter Medications in Older Adults: A Narrative Review of Pharmacy Involved Interventions and Recommendations for Improvement. Drugs Aging 2023:10.1007/s40266-023-01041-5. [PMID: 37340207 DOI: 10.1007/s40266-023-01041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Over-the-counter (OTC) medications are products that have been made easily accessible to allow patients to treat common ailments without a prescription and the cost of a doctor's visit. These medications are generally considered safe; however, there is still a potential for these medications to lead to adverse health outcomes. Older adults (ages 50+) are especially susceptible to these adverse health outcomes, due to age-related physiological changes, a higher prevalence of comorbidities, and prescription medication use. Many OTC medications are sold in pharmacies, which provides pharmacists and technicians with the opportunity to help guide safe selection and use for these medications. Therefore, community pharmacies are the ideal setting for OTC medication safety interventions. This narrative review summarizes the findings of pharmacy-involved interventions that promote safe OTC medication use for older adults.
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Affiliation(s)
- Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Maria E Berbakov
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Emily L Hoffins
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Jukrin Moon
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Lauren Welch
- William S. Middleton VA Geriatrics Research Education & Clinical Center, Madison, WI, USA
| | - Michelle A Chui
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
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Arentson-Lantz EJ, Deer RR, Kokonda M, Wen CL, Pecha TA, Carreon SA, Ngyen TM, Volpi E, Nowakowski S. Improvements in sleep quality and fatigue are associated with improvements in functional recovery following hospitalization in older adults. FRONTIERS IN SLEEP 2022; 1:1011930. [PMID: 37251511 PMCID: PMC10217784 DOI: 10.3389/frsle.2022.1011930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Study objectives Poor sleep quality, a frequent problem in older adults, has been shown to be associated with reduced physical function and wellbeing. However, little is known about the relationship between sleep quality and the recovery of physical function following hospitalization. Thus, we conducted this study to examine the association between sleep quality and functional recovery after an acute hospitalization in community dwelling older adults. Methods Older adult patients (N = 23, mean age = 74 ± 9 years) were recruited during an acute hospitalization (average length of stay 3.9 days) with a cardiovascular (56%), pulmonary (22%), or metabolic (13%) admission diagnosis. Objective physical function was measured using the Short Physical Performance Battery (SPPB) and self-reported function was assessed with Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living Scale (IADL). Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) global score and Iowa Fatigue Score (IFS). Testing was performed prior to discharge (baseline) and 4-weeks post-discharge (follow-up). Results Regression models showed PSQI Subjective Sleep Quality change scores from baseline to 4-week follow-up predicted a change in ADL (β = -0.22); PSQI Use of Sleep Medications change scores predicted a change in SPPB Total (β = 1.62) and SPPB Chair Stand (β = 0.63); IFS change scores predicted SPPB Total (β = -0.16) and SPPB Chair Stand performance (β = -0.07) change scores. Conclusions For older adults, changes in sleep medication use, daytime dysfunction, and fatigue were associated with improvements in functional recovery (including physical performance and independence) from acute hospitalization to 4-week follow-up. These results suggest that interventions focused on improving sleep quality, daytime consequences, and fatigue might help enhance physical functioning following hospitalization. Clinical trial registration ClinicalTrials.gov, identifier: NCT02203656.
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Affiliation(s)
- Emily J. Arentson-Lantz
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Rachel R. Deer
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
| | - Manasa Kokonda
- Center for Innovation in Quality, Effectiveness, and Safety, Michael DeBakey VA Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chelsey L. Wen
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Thomas A. Pecha
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Samantha A. Carreon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Trung M. Ngyen
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Sara Nowakowski
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
- Center for Innovation in Quality, Effectiveness, and Safety, Michael DeBakey VA Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Yang CC, Chien WC, Chung CH, Lai CY, Tzeng NS. The Usage of Histamine Type 1 Receptor Antagonist and Risk of Dementia in the Elderly: A Nationwide Cohort Study. Front Aging Neurosci 2022; 14:811494. [PMID: 35370616 PMCID: PMC8972197 DOI: 10.3389/fnagi.2022.811494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe histamine type 1 receptor antagonist (H1RA) has been commonly used. This study aimed to examine the association between the usage of H1RA and the risk of dementia.MethodsA total of 8,986 H1RA users aged ≥50 and 26,958 controls matched a ratio of 1:3 for age, sex, and comorbidity, were selected between January 1, and December 31, 2000, from Taiwan’s National Health Insurance Research Database. Fine and Gray’s survival analysis (competing with mortality) was used to compare the risk of developing dementia during a 15-year follow-up period (2000–2015).ResultsIn general, the H1RA usage was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 1.025, 95% confidence interval [CI] = 0.883–1.297, p = 0.274) for the H1RA cohort. However, a differential risk was found among the groups at risk. The patients with the usage of H1RA aged ≥65 years (adjusted SHR: 1.782, 95% CI = 1.368–2.168, p < 0.001) were associated with a higher risk of dementia, in comparison to the control groups. Furthermore, the patients with the usage of H1RA that were male, or had more comorbidities, were also associated with an increased risk of dementia.ConclusionThe usage of H1RA was associated with the risk of developing dementia in the patients aged ≥ 65 years.
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Affiliation(s)
- Chuan-Chi Yang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Hsinchu Branch, Hsinchu City, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chung-Yu Lai
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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Masse M, Henry H, Cuvelier E, Pinçon C, Pavy M, Beeuwsaert A, Barthélémy C, Cuny D, Gautier S, Kambia N, Lefebvre JM, Mascaut D, Mitoumba F, Puisieux F, Standaert A, Wierre P, Beuscart JB, Roche J, Décaudin B. Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist. Healthcare (Basel) 2022; 10:healthcare10010147. [PMID: 35052310 PMCID: PMC8775744 DOI: 10.3390/healthcare10010147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.
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Affiliation(s)
- Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
- Correspondence:
| | - Héloïse Henry
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Elodie Cuvelier
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Claire Pinçon
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Margot Pavy
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Audrey Beeuwsaert
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Christine Barthélémy
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Damien Cuny
- Univ. Lille, ULR 4515-LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France;
| | - Sophie Gautier
- Inserm, UMR-S1172, Center for Pharmacovigilance, CHU de Lille, University Lille, F-59037 Lille, France;
| | - Nicolas Kambia
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Jean-Marc Lefebvre
- Department of General Practice, University of Lille, F-50045 Lille, France;
| | - Daniel Mascaut
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Fabrice Mitoumba
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - François Puisieux
- Hôpital Gériatrique Les Bateliers, Pôle de Gérontologie, CHRU de Lille, F-59000 Lille, France;
| | - Annie Standaert
- Univ. Lille, Inserm, CHU Lille, U1286-INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
| | - Patrick Wierre
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de Gérontologie, F-59037 Lille, France;
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
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Alhwimani AK, Aljohani RA, Altulaihi BA. The Use of Over-the-Counter Sleep Aid Containing Diphenhydramine Hydrochloride Among Saudis. Cureus 2021; 13:e20622. [PMID: 35106193 PMCID: PMC8786564 DOI: 10.7759/cureus.20622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diphenhydramine is a first-generation H1 receptor antihistamine that is usually used for the treatment of allergy, insect bites such as mosquitos, bee stings, and some types of skin rashes. However, it possesses antiparkinsonian, antitussive, antiemetic, and most importantly hypnotic properties. This study aimed to assess the prevalence, frequency of use, and dosage of over-the-counter (OTC) sleep aid containing diphenhydramine hydrochloride used among Saudis. Material and Methods The study used a descriptive cross-sectional design conducted among the Saudi population. An online self-administered questionnaire was distributed among the selected Saudi nationality using social media platforms. The subjects included were Saudis aged 15 years or older, literate in using social media. The questionnaire included basic demographic characteristics, previous and current history of medication use that contains diphenhydramine hydrochloride, its side effects, and other related behavior of using, such as frequency of use and dosage. Results A total of 414 respondents were recruited (51% males and 49% females). Previous and current use of medications that contain diphenhydramine hydrochloride constituted 87.2% and 31.9%, respectively. The most common reason for using sleep aid was insomnia (52.1%). Dizziness or imbalance was the most commonly reported side effect. The Chi-square test revealed that the age group of ≤25 years (p = 0.044), female gender (p = 0.040), being a student (p = 0.015), current use of sleeping aid medications (p < 0.001), and the use of other medications (p < 0.001) were significantly associated with increased use of sleep aid medications. Conclusion The excessive use of over-the-counter (OTC) sleep aid medications containing diphenhydramine hydrochloride was widely prevalent among the Saudi population. Younger female students constitute the majority of OTC sleep aid medication users.
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Algarni M, Hadi MA, Yahyouche A, Mahmood S, Jalal Z. A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults. J Pharm Policy Pract 2021; 14:76. [PMID: 34517925 PMCID: PMC8439034 DOI: 10.1186/s40545-021-00350-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background Over-the-counter (OTC) medicines are typically safe. However, there is evidence that OTC medicines can sometimes cause harm as a result of their misuse, abuse and dependence. Aim of the review To review the literature on OTC medicines misuse, abuse and dependence in adults and identify the implicated medicines, contributing factors, associated harms and risk-mitigating interventions. Methods Following PRISMA guidelines, electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO Web of Science and Google Scholar were searched for peer-reviewed journal articles published in English between January 2011 and March 2019. Quantitative, qualitative and mixed-methods studies assessing aspects of misuse, abuse and dependence of OTC medicines in individuals aged 18 years or more were included. Studies that solely focused on adolescents only, doping in sports or abuse of OTC medicines in people who are substance abusers were excluded. The random effect meta-analysis model was used to pool the prevalence among the population-based studies. Results Of 2355 peer-reviewed studies initially identified, 53 were included in this review. According to the study design, the prevalence varied, but the overall pooled prevalence in the population-based studies was: 16.2% for misuse, 2.0% for abuse, and 7.2% for dependence. The common OTC medicines groups involved in the problematic use were analgesics (with or without codeine), sedative antihistamines, cough mixtures containing dextromethorphan. Physical, psychological, social and financial harms were associated with problematic use of OTC medicines in addition to hospitalisation and death. Interventions for the affected individuals were provided mainly through the community pharmacies, general practices and specialised addiction centres. Conclusion The problematic use of OTC medicines is quite prevalent in adults, necessitating raising public awareness about their safe use. In addition, innovative harm minimisation models need to be developed, evaluated and implemented across health care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00350-7.
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Affiliation(s)
- Mohammad Algarni
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, UK.
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, UK
| | - Asma Yahyouche
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, UK
| | - Sajid Mahmood
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, UK
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences (CMDS), University of Birmingham, Birmingham, UK
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Yang Y, Zhang L, Huang Y, Huang H, Sun S, Xiao J. Based on the Beers Criteria 2019 Edition Over-the-Counter Drugs Risk Confirmation of Elderly Chinese. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5524551. [PMID: 34485515 PMCID: PMC8410390 DOI: 10.1155/2021/5524551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore OTC (over-the-counter drugs) in Chinese community pharmacies often causes ADE (adverse drug event) in elderly patients. METHODS Use the drugs in the Beers Criteria 2019 potentially inappropriate medication use (PIM) list as search terms. Search for drugs registered on the National Medical Products Administration of China website before December 2019 to determine the drugs containing PIM active ingredients and, then, search the Chinese OTC selection and conversion catalog database to determine it as OTC. Two databases are considered to be the same drug if they have the same drug composition. RESULTS The incidence of PIM in elderly patients in our community is relatively high, and the management of OTC may be related to risk factors. Statistics found that 71 OTC contained the Beers Criteria ingredients, including 65 chemicals and six Chinese patent medicines. Varieties of compound preparations accounted for 78.9% and cold medicines accounted for 47.9%. CONCLUSIONS The high detection rate of the Beers Criteria in Chinese OTC suggests that medical practitioners in China, especially community pharmacists, should pay attention to the rational use of OTC in the elderly.
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Affiliation(s)
- Yongyu Yang
- Department of Pharmacy, The Second People's Hospital of Beihai, Beihai, Guangxi, China 536000
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008
- National Medical Center for Geriatrics, Xiangya Hospital, Central South University, Laboratory for Rational and Safe Use of Elderly, Changsha, Hunan, China 410008
| | - Yamin Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008
- National Medical Center for Geriatrics, Xiangya Hospital, Central South University, Laboratory for Rational and Safe Use of Elderly, Changsha, Hunan, China 410008
| | - Hangxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008
- National Medical Center for Geriatrics, Xiangya Hospital, Central South University, Laboratory for Rational and Safe Use of Elderly, Changsha, Hunan, China 410008
| | - Shusen Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfeld, MA 01119, USA
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan 410008, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008
- National Medical Center for Geriatrics, Xiangya Hospital, Central South University, Laboratory for Rational and Safe Use of Elderly, Changsha, Hunan, China 410008
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Kua CH, Lee SRE, Cheng SST, Lin JFY, Wang H, Lee GWF. Evaluating the optimization of the use of sedating antihistamines in a community pharmacy: a retrospective quality improvement study in Singapore. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:451-457. [PMID: 34244771 DOI: 10.1093/ijpp/riab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/31/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to retrospectively assess whether community pharmacy customers accepted the pharmacist's recommendations for the selection of an antihistamine based on medicine optimization guidelines. METHODS A retrospective study was conducted on the implementation of an antihistamine use optimization guide for patients who were seeking first-generation antihistamines between July and December 2019 across forty-five community pharmacies in Singapore. The primary outcome measure was the acceptance rate of ceasing or substituting first-generation antihistamine with a second-generation antihistamine. Secondary measures included the reduction in types of first-generation antihistamines used, adverse drug-related events reported, intended use of antihistamines and the types of recommendations. KEY FINDINGS During the study period, 2328 patients fulfilled the inclusion criteria, out of which 523 patients agreed to optimize their use of sedating first-generation antihistamines. Chlorpheniramine (95.2%) was the most widely accepted first-generation antihistamine for optimization, with 59.6% of the users experiencing adverse events, the most common being drowsiness (53.2%). The main indication of use was allergic conditions (allergic rhinitis or atopic dermatitis) (70.3%). After implementation of the guide, most interventions were direct substitution (72.8%) with a less-sedating antihistamine, followed by gradual tapering (22.6%). Loratadine, a second-generation antihistamine, was most frequently (51.4%) used to substitute first-generation antihistamines. The optimization guide can potentially reduce adverse effects in 59.6% (297 patients) of chlorpheniramine users, which were mainly drowsiness (265 patients; 53.2%) and dry mouth (14 patients; 2.8%). CONCLUSIONS This study highlighted the importance of assessing and reducing potentially inappropriate first-generation antihistamine self-use and that a guided approach and substitution with less-sedating antihistamines can be employed in the community pharmacy setting.
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Affiliation(s)
- Chong-Han Kua
- School of Applied Science, Republic Polytechnic, Singapore, Singapore
| | - Shawn Rong En Lee
- Pharmacy Practice Department, Guardian Health and Beauty, Singapore, Singapore
| | | | - Joanne Fang Yun Lin
- Pharmacy Practice Department, Guardian Health and Beauty, Singapore, Singapore
| | - Hui Wang
- Pharmacy Practice Department, Guardian Health and Beauty, Singapore, Singapore
| | - Grace Wai Fong Lee
- Pharmacy Practice Department, Guardian Health and Beauty, Singapore, Singapore
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Morris AO, Gilson A, Chui MA, Xiong K. Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection. Res Social Adm Pharm 2021; 17:2116-2126. [PMID: 34266754 DOI: 10.1016/j.sapharm.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adults aged 65+ (older adults) disproportionately consume 30% of over-the-counter (OTC) medications and are largely responsible for making OTC treatment decisions because providers lack awareness of their consumption. These treatment decisions are complex: older adults must navigate age-related body/cognitive changes, developed comorbidities, and complex medication regimens when selecting the right OTC. Yet little is known about how older adults make such decisions. OBJECTIVES This study characterizes older adults' cognitive decision-making process when seeking to self-medicate with OTCs from their community pharmacy, and demonstrates how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making. METHODS A pre-/post-implementation approach, using a think-aloud interview process, was conducted with older adults within a community pharmacy setting as they completed a hypothetical scenario to treat either pain, sleep, or cough/cold/allergy symptoms. HTA developed a conceptualization of older adult decision-making regarding OTC selection and use before/after Senior Section implementation. RESULTS An HTA constructed from 12 purposefully-selected interviews (pre-n = 9/post-n = 3), consisting of 8 goals/15 sub-goals. While selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The intervention reduced by half the number of factors considered. IMPLICATIONS Older adult decision-making is more complex than just selecting OTC medication from a pharmacy shelf. HTA-informed decision profiles can provide pharmacists critical insights into safety issues that older adults may not be considering (e.g., factors related to safety, strength, or appropriateness of OTC for symptoms) so that pharmacists can support their decision-making.
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Affiliation(s)
- Ashley O Morris
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, 777 Highland Ave., Madison, WI, USA.
| | - Aaron Gilson
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI, USA
| | - Michelle A Chui
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, 777 Highland Ave., Madison, WI, USA; Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI, USA
| | - Ka Xiong
- Wisconsin Department of Health Services, 1 W Wilson St, Madison, WI, USA
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Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. A Case of Massive Diphenhydramine and Naproxen Overdose. J Emerg Med 2021; 61:259-264. [PMID: 34148773 DOI: 10.1016/j.jemermed.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diphenhydramine, a first generation H1 histamine receptor antagonist, is a commonly used nonprescription medication that is used for the treatment of allergy, as a sleep aid, or combined with cough and cold remedies. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is used commonly for analgesia. Although most cases of diphenhydramine or naproxen overdose require excellent supportive care only, meticulous attention should be given to cardiovascular and neurologic status. CASE REPORT A 22-year-old woman presented with altered mental status secondary to intentional ingestion of 240 combination caplets of naproxen sodium 220 mg and diphenhydramine hydrochloride 25 mg. While in the emergency department, she manifested a wide-complex tachycardia in the setting of hypotension that required repeated administration of sodium bicarbonate to overcome the sodium channel blockade caused by diphenhydramine. Aggressive potassium repletion was performed simultaneously. Her clinical course was complicated by status-epilepticus that required intubation. Orogastric lavage was performed, which returned blue pill slurry consistent with the ingested caplets. The patient was extubated on hospital day 2 and transferred to psychiatry thereafter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In light of recent social media trends, such as the "Benadryl challenge" and its widespread availability, emergency providers should be familiar with diphenhydramine toxicity, especially the life-threatening neurologic consequences and risk of cardiovascular collapse. NSAIDs, such as naproxen, and other nonprescription analgesics are becoming more and more important in light of the current opioid crisis. There should be an emphasis on understanding these medications and their potential implications when taken in overdose.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Timothy Backus
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Emma Furlano
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Mary Ann Howland
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; St. John's University College of Pharmacy and Health Sciences, Jamaica, New York
| | - Silas W Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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Cheung JMY, Jarrin DC, Beaulieu-Bonneau S, Ivers H, Morin G, Morin CM. Patterns of Concomitant Prescription, Over-the-Counter and Natural Sleep Aid Use over a 12-Month Period: A Population Based Study. Sleep 2021; 44:6294002. [PMID: 34089619 DOI: 10.1093/sleep/zsab141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Concomitant patterns of sleep aid use may provide insight for understanding the transition to chronic sleep medication use. Therefore, we sought to characterize the trajectories of concomitant natural product (NP), over-the-counter (OTC), and prescribed (Rx) sleep aid use in a population-based sample over 12-months. METHODS Self-reported data on the use of NP, OTC, and Rx sleep aids were extracted from a Canadian longitudinal study on the natural history of insomnia (N=3416, M age = 49.7±14.7 years old; 62% women) at baseline, 6 months and 12 months. Latent class growth modeling was used to identify latent class trajectories using MPlus 7. Participants completed a battery of clinical measures: Ford Insomnia Response to Stress Test, abbreviated Dysfunctional Beliefs and Attitudes about Sleep Scale, Beck Depression Inventory, Insomnia Severity Index and, the Pittsburgh Sleep Quality Index. Associations between class membership and baseline covariates were evaluated. RESULTS Concurrent sleep aid use fell into six distinct latent class trajectories over a 12-month period: Minimal Use (74.5%), Rx-Dominant (11.3%), NP-Dominant (6.3%), OTC-Dominant (4.3%), Rx-NP-Dominant (2.4%), and Rx-OTC-Dominant (1.1%). The three latent classes with prominent prescribed agent use predicted greater incidence of healthcare professional consultations for their sleep (p< 0.05), poorer sleep quality (p< 0.001), elevated dysfunctional sleep beliefs (p< 0.001), and sleep reactivity (p< 0.001). Compared to the other four latent classes, clinical profiles of Rx-NP-dominant and Rx-OTC-dominant groups endorsed greater severity across measures. CONCLUSIONS Patterns of sleep aid use may provide insight for identifying individuals who may be vulnerable to inappropriate self-medicating practices.
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Affiliation(s)
- Janet M Y Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre d'étude des troubles du sommeil, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
| | | | - Simon Beaulieu-Bonneau
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, QC, Canada
| | - Hans Ivers
- École de psychologie, Université Laval, Québec, QC, Canada
| | | | - Charles M Morin
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre d'étude des troubles du sommeil, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
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13
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Nemanich A, Liebelt E, Sabbatini AK. Increased rates of diphenhydramine overdose, abuse, and misuse in the United States, 2005-2016. Clin Toxicol (Phila) 2021; 59:1002-1008. [PMID: 33688782 DOI: 10.1080/15563650.2021.1892716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe trends in abuse, misuse, and suicide attempts involving diphenhydramine (DPH). METHODS We analyzed intentional DPH exposures of individuals ≥10 years old reported to U.S. Poison Control Centers using data from the National Poison Data System, 2005-2016. RESULTS There were 158,774 intentional DPH exposures in our dataset. The rate of intentional exposures increased 63% over the 12-year study period for all ages combined. Suicide attempts involving DPH showed a bimodal distribution-increasing 263% among children 10-14 years of age, and 126 and 143% among those 55-64 and ≥65 years of age, respectively. Older adults in both the 55-64 and ≥65-year-old age groups had about a 230% increase in rates of misuse. Major adverse clinical effects increased by 91%. There were 745 total reported deaths with a 3.6% increase across all age groups. CONCLUSIONS Intentional DPH exposures among individuals ≥10 years old have been increasing since 2005. Increasing rates of suicide attempts among children ages 10-14 and increasing misuse among individuals ≥65, coupled with a trend toward greater severity of overdoses, highlight the significant public health impact of this commonly available over-the-counter drug.
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Affiliation(s)
- Antonia Nemanich
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | | | - Amber K Sabbatini
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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14
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Mohamed MR, Ramsdale E, Loh KP, Xu H, Patil A, Gilmore N, Obrecht S, Wells M, Nightingale G, Juba KM, Faller B, Onitilo A, Bradley T, Culakova E, Holmes H, Mohile SG. Association of Polypharmacy and Potentially Inappropriate Medications With Physical Functional Impairments in Older Adults With Cancer. J Natl Compr Canc Netw 2021; 19:267-274. [PMID: 33482631 PMCID: PMC8295406 DOI: 10.6004/jnccn.2020.7628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/23/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIMs) are prevalent in older adults with cancer, but their associations with physical function are not often studied. This study examined the associations of polypharmacy and PIMs with physical function in older adults with cancer, and determined the optimal cutoff value for the number of medications most strongly associated with physical functional impairment. METHODS This cross-sectional analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment. We categorized PIM using 2015 American Geriatrics Society Beers Criteria. Three validated physical function measures were used to assess patient-reported impairments: activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, and the Older Americans Resources and Services Physical Health (OARS PH) survey. Optimal cutoff value for number of medications was determined by the Youden index. Separate multivariate logistic regressions were then performed to examine associations of polypharmacy and PIMs with physical function measures. RESULTS Among 439 patients (mean age, 76.9 years), the Youden index identified ≥8 medications as the optimal cutoff value for polypharmacy; 43% were taking ≥8 medications and 62% were taking ≥1 PIMs. On multivariate analysis, taking ≥8 medications was associated with impairment in ADL (adjusted odds ratio [aOR], 1.64; 95% CI, 1.01-2.58) and OARS PH (aOR, 1.73; 95% CI, 1.01-2.98). PIMs were associated with impairments in IADL (aOR, 1.72; 95% CI, 1.09-2.73) and OARS PH (aOR, 1.97; 95% CI, 1.15-3.37). A cutoff of 5 medications was not associated with any of the physical function measures. CONCLUSIONS Physical function, an important component of outcomes for older adults with cancer, is cross-sectionally associated with polypharmacy (defined as ≥8 medications) and with PIMs. Future studies should evaluate the association of polypharmacy with functional outcomes in this population in a longitudinal fashion.
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Affiliation(s)
- Mostafa R Mohamed
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Erika Ramsdale
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Kah Poh Loh
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Huiwen Xu
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Amita Patil
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Nikesha Gilmore
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Spencer Obrecht
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Megan Wells
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Ginah Nightingale
- 2Department of Pharmacy Practice, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine M Juba
- 3Department of Pharmacy, University of Rochester Medical Center, Rochester, New York
| | - Bryan Faller
- 4Missouri Baptist Medical Center, St. Louis, Missouri
| | | | - Thomas Bradley
- 6Zucker School of Medicine at Hofstra-Northwell, Lake Success, New York; and
| | - Eva Culakova
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Holly Holmes
- 7The University of Texas Health Science Center at Houston, Houston, Texas
| | - Supriya G Mohile
- 1James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
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Meredith S, Frawley J, Sibbritt D, Adams J. A critical review of self-care for sleep disturbances: prevalence, profile, motivation, perceived effectiveness and medical provider communication. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-019-0039-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Objective
This study aims to undertake the first critical review of self-care use among adults with sleep disturbances by focusing on the prevalence of self-care—the self-determined and self-administered use of products or practices—by adults with sleep disturbances.
Methods
A comprehensive search of 2006–2016 international literature in CINAHL, AMED, Medline and EMBASE databases was conducted. The search was confined to empirical research findings regarding sleep disturbances - as indicated by a validated sleep scale/index or clinician diagnosis.
Results
Of the 21 articles included in this review, only three reported on sleep disturbances other than insomnia disorder (ID) or insomnia symptoms (IS). Overall, a high prevalence of self-care use is reported among adults with sleep disturbances, particularly for ID and IS. Self-care products and practices are more likely to be used by adults with sleep disturbances, than those without sleep disturbances. Commonly used self-care products and practices include OTC hypnotics, antihistamines, diphenhydramine products, diet, exercise, painkillers, herbal medicines, vitamins, minerals and dietary supplements, yoga, tai chi, Qigong, meditation, exercise and relaxation.
Conclusions
Many adults with sleep disturbances–particularly ID or IS–frequently use self-care products and practices. Self-care products are also used concomitantly with conventional prescription medications without disclosure to medical professionals. The current literature is of varied methodological caliber, frequently relies on small sample sizes and low-quality data collection therefore further rigorous health services research is required. There is an especial paucity of data regarding self-care for sleep disturbances such as restless legs syndrome and obstructive sleep apnea. Healthcare providers may find it beneficial to actively ask patients about their use of self-care for sleep disturbances to help avoid harmful drug-drug or drug-herb interactions.
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16
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Toepfer S, Bolbrinker J, König M, Steinhagen-Thiessen E, Kreutz R, Demuth I. Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) - Sex differences and associations with morbidity and medication use. PLoS One 2019; 14:e0226511. [PMID: 31887163 PMCID: PMC6936809 DOI: 10.1371/journal.pone.0226511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Multimorbidity in advanced age and the need for drug treatment may lead to polypharmacy, while pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug events (ADEs). Objective The aim of this study was to determine the proportion of subjects using potentially inappropriate medication (PIM) in a cohort of older and predominantly healthy adults in relation to polypharmacy and morbidity. Methods Cross-sectional data were available from 1,382 study participants (median age 69 years, IQR 67–71, 51.3% females) of the Berlin Aging Study II (BASE-II). PIM was classified according to the EU(7)-PIM and German PRISCUS (representing a subset of the former) list. Polypharmacy was defined as the concomitant use of at least five drugs. A morbidity index (MI) largely based on the Charlson Index was applied to evaluate the morbidity burden. Results Overall, 24.1% of the participants were affected by polypharmacy. On average, men used 2 (IQR 1–4) and women 3 drugs (IQR 1–5). According to PRISCUS and EU(7)-PIM, 5.9% and 22.6% of participants received at least one PIM, while use was significantly more prevalent in females (25.5%) compared to males (19.6%) considering EU(7)-PIM (p = 0.01). In addition, morbidity in males receiving PIM according to EU(7)-PIM was higher (median MI 1, IQR 1–3) compared to males without PIM use (median MI 1, IQR 0–2, p<0.001). Conclusion PIM use occurred more frequently in women than in men, while it was associated with higher morbidity in males. As expected, EU(7)-PIM identifies more subjects as PIM users than the PRISCUS list but further studies are needed to investigate the differential impact of both lists on ADEs and outcome. Key points We found PIM use to be associated with a higher number of regular medications and with increased morbidity. Additionally, we detected a higher prevalence of PIM use in females compared to males, suggesting that women and people needing intensive drug treatment are patient groups, who are particularly affected by PIM use.
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Affiliation(s)
- Sarah Toepfer
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Juliane Bolbrinker
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Maximilian König
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Reinhold Kreutz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Ilja Demuth
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
- Berlin Insitute of Health Center for Regenerative Therapies”oder ausführlicher „Charité—Universitätsmedizin Berlin, BCRT—Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
- * E-mail:
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17
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Nguyen K, Watanabe J. Association Between Sleep Medications and Falls and Fall-related Worries in Community-Dwelling Older Adults in the United States. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp18-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background
Falls are the leading cause of unintentional fatal and nonfatal injuries in seniors. Sleep medications are associated with adverse events risk in older adults. The objective of this study is to quantify the relationship between different levels of sleep medication use with falls and fall-related worries in United States adults aged 65 years and older using a nationally representative sample.
Methods
Using the 2011 National Health and Aging Trends Study, survey-weighted multiple logistic regression was used to determine the association between participants who reported sleep medication use and the outcomes: falls in the last month, falls in the last year, multiple falls in the last year, fall-related worries, and limitation of activities due to fall-related worries.
Results
In adjusted analyses, older adults who used sleep medications every night compared to non-users of sleep medications were at increased odds of falls in the last year with an odds ratio (OR) of 1.51 (95% confidence limit [CL] 1.27, 1.78) and of multiple falls with an OR = 1.67 (95% CL 1.35, 2.06). For those who used sleep medications less than every night compared to non-users, there were no statistically significant increased odds of fall outcomes. Older adults who used sleep medication most nights (5–6 nights per week) and every night compared to non-users had increased odds of having fall-related worries with an OR = 1.61 (95% CL 1.06, 2.45) and an OR = 1.32 (95% CL 1.11, 1.58), respectively.
Conclusion
Older adults who use sleep medication every night are at greater odds of experiencing falls and having fall-related worries. Increased involvement by pharmacists in the community setting and pharmacist-led comprehensive medication reviews are efforts that may reduce sleep medication use and result in fewer falls in older adults.
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18
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Should Melatonin Be Used as a Sleeping Aid for Elderly People? Can J Hosp Pharm 2019; 72:327-329. [PMID: 31452545 PMCID: PMC6699865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Khojah HM. Do pharmacists counsel customers about the effects of sedating antihistamines on driving skills? A survey of community pharmacies in Saudi Arabia. J Int Med Res 2019; 47:2018-2025. [PMID: 30885078 PMCID: PMC6567744 DOI: 10.1177/0300060519838953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the level of counselling regarding the effects of sedating antihistamines on driving skills provided by private community pharmacies in Madinah, Saudi Arabia. Methods This study randomly selected private community pharmacies. Mystery shoppers following a similar scenario individually visited these pharmacies. These clients asked for a commonly used brand of sedating antihistamine and noted the counselling offered by the pharmacist. If spontaneous counselling was not offered, necessary information regarding the medication’s use was requested. Finally, the content of counselling was documented. Results Of the 100 pharmacies selected, 12 were excluded for various reasons and 88 pharmacies were included in the study. Only 23 pharmacies offered spontaneous counselling. Although 73.9% of pharmacists (65 of 88), spontaneously or upon request, mentioned sedation as a side-effect, only one pharmacist warned the client against driving after taking the medication, and three other pharmacists warned against dealing with hazardous machinery. Other side-effects were almost ignored. Conclusion A life-threatening insufficiency in the quality of counselling at Saudi Arabian private community pharmacies exists. Traffic accidents, secondary to the side-effects of sedating antihistamines, may be avoided if proper counselling is offered. Saudi Arabian authorities should take appropriate actions to ensure optimal practice in community pharmacies.
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Affiliation(s)
- Hani Mj Khojah
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
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20
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Obara K, Ao L, Ogawa T, Ikarashi T, Yamaki F, Matsuo K, Yoshio T, Tanaka Y. Assessment of Inhibitory Effects of Hypnotics on Acetylcholine-Induced Contractions in Isolated Rat Urinary Bladder Smooth Muscle. Biol Pharm Bull 2019; 42:280-288. [DOI: 10.1248/bpb.b18-00829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Keisuke Obara
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Lin Ao
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Tsukasa Ogawa
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Takumi Ikarashi
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Fumiko Yamaki
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Takashi Yoshio
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
| | - Yoshio Tanaka
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University
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21
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Maust DT, Solway E, Clark SJ, Kirch M, Singer DC, Malani P. Prescription and Nonprescription Sleep Product Use Among Older Adults in the United States. Am J Geriatr Psychiatry 2019; 27:32-41. [PMID: 30409547 DOI: 10.1016/j.jagp.2018.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Older adults commonly use products that may be used to promote sleep, such as benzodiazepines and over-the-counter medications, but the current extent of use of both prescription and nonprescription products specifically for sleep in the United States is unknown. METHODS Respondents in this cross-sectional, nationally representative survey (the National Poll on Healthy Aging) of community-dwelling older adults aged 65-80 (n = 1,065) reported difficulty initiating sleep or early awakening ("sleep symptoms") and use of prescription medication or nonprescription aids to promote sleep ("sleep product"), including prescription sleep medication, over-the-counter (OTC) sleep aids, prescription pain medication, and herbal/natural sleep aids. Logistic regression was used to determine the association of respondent sociodemographic and clinical characteristics with the use of sleep products. RESULTS Sleep symptoms were endorsed by 67.7% of respondents (95% confidence interval [CI] 64.7%-70.7%). Use of a sleep product was reported by 35.4% (95% CI 32.4%-38.6%), with 21.9% (95% CI 19.4%-24.7%) using OTC sleep aids, 12.5% using herbal/natural aids (95% CI 10.6%-14.8%), 8.3% using prescription sleep medication (95% CI 6.7%-10.3%), and 5.0% using prescription pain medication (95% CI 3.8%-6.7%). Self-reported fair/poor mental health (relative to excellent/very good) was associated with increased odds of sleep product use (adjusted odds ratio 2.28, 95% CI 1.10-4.72, p = 0.03). CONCLUSION More than a third of older adults use medications or aids to help with sleep-most commonly OTC aids. Clinicians should routinely ask older patients about sleep-related difficulties and the use of nonprescription sleep aids.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Sarah J Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Dianne C Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Preeti Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Medicine, University of Michigan, Ann Arbor, MI
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Leahy LG. Caution is Key When Prescribing for Older Adults. J Psychosoc Nurs Ment Health Serv 2017; 55:7-10. [PMID: 29194557 DOI: 10.3928/02793695-20171113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The end of the year can trigger the recognition that aging adults are no longer as independent as they once were. Psychiatric nurses and other mental health professionals may see an increase in older adults being referred for treatment. As the most appropriate psychosocial/psychotherapeutic and psychopharmacological treatments are identified for older adults, there are some unique challenges inherent in coordinating the care of this population. It is especially important for prescribing psychiatric advanced practice nurses to update, review, and cross-reference older patients' lists of medications at every appointment. Although the obstacles to treating older adults may appear daunting, prudent, responsible, cautious practice should be exercised to ensure they achieve improved functionality, maintain safety, reduce risks, and enhance their quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 7-10.].
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23
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Marvanova M, Henkel PJ. Community Pharmacists' Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD. PHARMACY 2017; 5:pharmacy5030042. [PMID: 28970454 PMCID: PMC5622354 DOI: 10.3390/pharmacy5030042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/12/2023] Open
Abstract
Alzheimer's disease (AD) impacts millions of individuals worldwide. Since no cure is currently available, acetylcholinesterase inhibitors are symptomatic therapy. This study assessed community pharmacists' knowledge regarding donepezil adverse effects (AEs) and self-care recommendations for insomnia management for persons with AD treated with rivastigmine. This is a cross-sectional, standardized telephone survey of community pharmacists (n = 862) in three study areas: West Virginia, North Dakota/South Dakota, and Southern Oregon/Northern California. Pharmacists' degree, sex, and pharmacists' AD-related knowledge were assessed. In-stock availability of donepezil and rivastigmine formulations was assessed. Analyses were performed using Stata 10.1. Only 31.4% pharmacists were able to name ≥2 donepezil AEs. Only four donepezil AEs were named by at least 13% of pharmacists: nausea (36.1%), dizziness (25.1%), diarrhea (15.0%), and vomiting (13.9%). All other AEs were named by fewer than 7% of respondents. Only 62.9% of pharmacists (n = 542) provided appropriate recommendations: melatonin (40.3%), referral to physician (22.0%), or sleep hygiene (0.6%). Over 12% of pharmacists (n = 107) provided inappropriate recommendations (anticholinergic agent or valerian root) and 21.5% of pharmacists were unable to provide any recommendation. We identified significant gaps in community pharmacists' knowledge regarding donepezil AEs and non-prescription insomnia recommendation needing significant improvement to ensure high-quality AD-related care.
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Affiliation(s)
- Marketa Marvanova
- Department of Pharmacy Practice, School of Pharmacy/College of Health Professions, North Dakota State University, Department 2650, P.O. Box 6050, Fargo, ND 58108-6050, USA.
| | - Paul Jacob Henkel
- Department of Geographical and Historical Studies, University of Eastern Finland, FI-80101 Joensuu, Finland.
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24
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Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep, a Letter. Int J Clin Pharm 2017. [PMID: 28620842 DOI: 10.1007/s11096-017-0500-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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