Table 2.
Prevalence of potentially inappropriate prescribing by individual STOPP criteria among older people in CPRD
| Criteria description | Number of patients (N = 1,019,491) | % of patients (95% CIs) |
|---|---|---|
|
Cardiovascular system |
|
|
| Digoxin > 125 mcg/day
(increased risk of toxicity)
a
|
9327 |
0.9 (0.8-0.9) |
| Thiazide diuretics with gout
(exacerbates gout)
|
6094 |
0.6 (0.6-0.6) |
| Beta-blocker + verapamil
(risk of symptomatic heart block)
|
503 |
0.05 (0.05-0.05) |
| Aspirin + Warfarin without a PPI/ H2RA
(high risk of gastrointestinal bleeding)
|
3616 |
0.4 (0.3 -0.4) |
| Dipyridamole as monotherapy for cardiovascular secondary prevention
(no evidence of efficacy)
|
2137 |
0.2 (0.2-0.2) |
| Aspirin > 150 mg/day (
increased bleeding risk)
|
5128 |
0.5 (0.5-0.5) |
| Loop diuretic for dependent ankle oedema only i.e. no clinical signs of heart failure
(no evidence of efficacy, compression hosiery usually more appropriate)
|
25843 |
2.54 (2.5-2.6) |
| Loop diuretic as first-line monotherapy for hypertension
(safer, more effective alternatives available)
|
7128 |
0.7 (0.7-0.7) |
| Non-cardioselective beta-blocker with Chronic Obstructive Pulmonary Disease (COPD)
(risk of bronchospasm)
|
353 |
0.03 (0.03-0.03) |
| Calcium channel blockers with chronic constipation
(may exacerbate constipation)
|
16826 |
1.6 (1.6-1.7) |
| Aspirin with a past history of peptic ulcer disease without histamine H2 receptor antagonist or Proton Pump Inhibitor
(risk of bleeding)
|
3912 |
0.4 (0.4-0.4) |
| Aspirin with no history of coronary, cerebral or peripheral vascular symptoms or occlusive arterial event
(not indicated)
|
115576 |
11.3 (11.3-11.4) |
|
Central Nervous System |
|
|
| TCAs with dementia
(worsening cognitive impairment)
|
354 |
0.03 (0.03-0.03) |
| TCAs with glaucoma
(exacerbate glaucoma)
|
354 |
0.03 (0.03-0.03) |
| TCAs with opioid or calcium channel blocker
(risk of severe constipation)
|
26649 |
2.6 (2.6-2.6) |
| Long-term (>1 month) long-acting benzodiazepines
(risk of prolonged sedation, confusion, impaired balance, falls)
|
15057 |
1.5 (1.5-1.5) |
| Long-term (>1 month) neuroleptics (antipsychotics) (
risk of confusion, hypotension, extrapyramidal side-effects, falls)
|
21012 |
2.1 (2.1-2.1) |
| Long- term (>1 month) neuroleptics with parkinsonism
(worsen extrapyramidal symptoms)
|
852 |
0.1 (0.1-0.1) |
| Anticholinergics to treat extrapyramidal symptoms of neuroleptic medications
(risk of anticholinergic toxicity)
|
869 |
0.1 (0.1-1.0) |
| Phenothiazines with epilepsy
(may lower seizure threshold)
|
448 |
0.04 (0.04-0.04) |
| Prolonged use (>1 week) of first-generation anti-histamines
(risk of sedation and anti-cholinergic side-effects)
|
6020 |
0.6 (0.6-0.6) |
| TCA’s with cardiac conductive abnormalities |
543 |
0.05 (0.05-0.05) |
| TCA’s with prostatism or prior history of urinary retention
(risk of urinary retention)
|
2623 |
0.3 (0.3-0.3) |
| TCA’s with constipation
(likely to worsen constipation)
|
7279 |
0.7 (0.7-0.7) |
|
Gastrointestinal System |
|
|
| Prochlorperazine or metoclopramide with parkinsonism
(risk of exacerbating parkinsonism)
|
385 |
0.04 (0.04) |
| PPI for peptic ulcer disease at maximum therapeutic dosage for > 8 weeks
(dose reduction or earlier discontinuation indicated)
|
38153 |
3.7 (3.7-3.8) |
| Anticholinergic antispasmodic drugs with chronic constipation
(risk of exacerbation of constipation)
|
1208 |
0.1 (0.1-0.1) |
|
Respiratory system |
|
|
| Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD
(unnecessary exposure to long-term side-effects of systemic steroids)
|
1339 |
0.1 (0.1-0.1) |
| Nebulised ipatropium with glaucoma (
exacerbate glaucoma
) |
20 |
0 |
|
Musculoskeletal system |
|
|
| Long term NSAID use (>3 months) with osteoarthritis
(simple analgesics preferable)
|
12167 |
1.2 (1.2-1.2) |
| Warfarin and NSAID use
(risk of gastrointestinal bleeding)
|
2495 |
0.2 (0.2-0.3) |
| Non-steroidal anti-inflammatory drug (NSAID) with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent histamine H2 receptor antagonist, PPI or misoprostol
(risk of peptic ulcer relapse)
|
1040 |
0.1 (0.1-0.1) |
| NSAID with heart failure
(risk of exacerbation of heart failure)
|
409 |
0.04 (0.04-0.04) |
| NSAID with chronic renal failure
(risk of deterioration in renal function)
|
928 |
0.1 (0.1-0.1) |
| Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthrtitis or osteoarthritis
(risk of major systemic corticosteroid side-effects)
|
718 |
0.1 (0.1-0.1) |
| Long-term NSAID or colchicine for chronic treatment of gout where there is no contraindication to allopurinol
(allopurinol first choice prophylactic drug in gout)
|
2845 |
0.3 (0.3-0.3) |
|
Urinary System |
|
|
| Antimuscarinic drugs (urinary) with dementia
(risk of increased confusion and agitation)
|
297 |
0.03 (0.03-0.03) |
| Antimuscarinic drugs with chronic glaucoma
(risk of acute exacerbation of glaucoma)
|
109 |
0.01 (0.01-0.01) |
| Bladder antimuscarinic drugs with chronic constipation
(risk of exacerbation of constipation)
|
3514 |
0.3 (0.3-0.4) |
| Bladder antimuscarinic drugs with chronic prostatism
(risk of urinary retention)
|
2791 |
0.3 (0.3-0.3) |
| Alpha-blockers in males with frequent incontinence i.e. one or more episodes of incontinence daily
(risk of urinary frequency and worsening of incontinence)
|
1426 |
0.1 (0.1-0.2) |
| Alpha-blockers with long-term urinary catheter in situ i.e. more than 2 months
(drug not indicated)
|
31226 |
3.1 (3.0-3.1) |
|
Endocrine system |
|
|
| Beta-blockers in those with diabetes mellitus and frequent hypoglycaemic episodes
(risk of masking hypoglycaemic symptoms)
|
26563 |
2.6 (2.6-2.6) |
| Glibenclamide with type 2 diabetes mellitus
(risk of prolonged hypoglycaemia)
|
981 |
0.1 (0.1-0.1) |
| H. Drugs that adversely affect those prone to falls (≥1 fall in past three months) |
|
0.3 (0.3-0.3) |
| 1. Benzodiazepines
(sedative, may cause reduced sensorium, impair balance)
|
3358 |
0.2 (0.2-0.3) |
| 2. Neuroleptic drugs
(may cause gait dyspraxia, Parkinsonism)
|
2491 |
|
| 3. Firstgeneration antihistamines
(sedative, may impair sensorium)
|
250 |
0.02 (0.02-0.02) |
| 4. Vasodilator drugs
(postural hypotension)
|
788 |
0.1 (0.1-0.1) |
| 5. Long-term opiates in those with recurrent falls |
10321 |
1.0 (0.1-1.0) |
| Two concurrent drugs from the same group- therapeutic duplication (optimization of monotherapy within a single drug class) | 121668 | 11.9 (11.9-12.0) |
aItalised text in brackets represents the potential risk associated with the PIP indicators.