Table 3.
Examples of irrational prescribing
| Reason | Example |
|---|---|
| Low chance of benefit (compared with harm) | |
| Short-term conditions with good prognosis | Antiviral drugs for influenza in healthy adults |
| Preventive therapy in patients with poor
prognosis conditions/poor quality of life |
Statin therapy in patients with a malignancy |
| Drugs used beyond the evidence base | Statin therapy for very young or very old patients |
| Dose too low | ACEIs for chronic heart failure |
| Wrong diagnosis | Anti-anginal drugs for patients with GORD
Antibiotics for viral illnesses |
| Increased risk of harm (compared with benefit) | |
| Vulnerability to adverse effects | Prescribing psychoactive medicines for elderly patients; NSAIDs for patients with
impaired renal function; thromboprophylaxis in patients at risk of serious bleeding due to factors such as thrombocytopenia, peptic ulcer disease, coagulopathies, intracranial disease |
| Drug clearance altered | Wrong doses in patients with renal or hepatic disease |
| Drug interactions likely | Enzyme-inhibiting drugs (eg macrolide antibiotics) in patients taking warfarin |
| Dose too high | Thiazide diuretics prescribed in chronic heart failure dosage to treat hypertension
Aspirin prescribed in analgesic dosage for the prevention of cardiovascular disease |
| Reduced adherence likely | |
| Too many medicines (polypharmacy) in patients with multiple conditions | Prescribing all evidence-based therapies in older patients with chronic airways disease, hypertension, chronic heart failure, osteoporosis, GORD and diabetes |
| Poor communication | Antihypertensive drugs in young patients unclear about or unimpressed with the extent of the likely benefit |
| Unnecessary cost | |
| Expensive drugs with no evidence of superior outcomes | Prescribing branded rather than generic statins in primary prevention when these are more expensive |
| Expensive drugs that offer slightly better outcomes at enormously increased cost | Some new therapies for cancer |
| Drugs for adverse drug reactions | |
| Drugs prescribed to counteract the adverse effects of other medicines that could be replaced with suitable alternatives | Laxatives for verapamil-induced constipation
Salbutamol for beta-adrenoceptor antagonist-induced bronchospasm Loop diuretics for amlodipine-induced ankle oedema |
ACEI = angiotensin-converting enzyme inhibitor; GORD = gastro-oesophageal reflux disease; NSAID = non-steroidal anti-inflammatory drug.