Table 2.
Number of PIMs and those changed after pharmacist suggestion
| Criteriaa | Detected (n = 432) | Suggested (n = 189) | Changed (n = 172) |
|---|---|---|---|
| STOPP-v2 | 358 | 168 | 151 |
| Drug indication criteria | |||
| Any drug prescribed without an evidence-based clinical indication | 84 | 75 | 67 |
| Any duplicate drug class prescription | 10 | 5 | 5 |
| Cardiovascular System criteria | |||
| Beta-blocker in combination with verapamil or diltiazem | 1 | 0 | 0 |
| Thiazide diuretic with current significant hypokalaemia, hyponatraemia, hypercalcaemia or with a history of gout | 1 | 1 | 1 |
| ACE inhibitors or Angiotensin Receptor Blockers in patients with hyperkalaemia | 7 | 3 | 3 |
| Coagulation System criteria | |||
| Aspirin, clopidogrel, dipyridamole, vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors with concurrent significant bleeding risk | 1 | 1 | 1 |
| Ticlopidine in any circumstances | 4 | 3 | 3 |
| NSAID and vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors in combination | 1 | 1 | 1 |
| NSAID with concurrent antiplatelet agents without PPI prophylaxis | 1 | 0 | 0 |
| Central Nervous System criteria | |||
| Benzodiazepines for ≥4 weeksb | 108 | 20 | 16 |
| Antipsychotics in those with parkinsonism or Lewy Body Disease | 3 | 1 | 1 |
| Anticholinergics/antimuscarinics in patients with delirium or dementia | 5 | 4 | 3 |
| First-generation antihistamines | 3 | 3 | 3 |
| Renal System criteria | |||
| NSAIDs if eGFR < 50 mL/min/1.73m2 | 5 | 3 | 3 |
| Gastrointestinal System criteria | |||
| PPI for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for > 8 weeks | 28 | 12 | 11 |
| Drugs likely to cause constipation in patients with chronic constipation where non-constipating alternatives are appropriate | 3 | 1 | 0 |
| Respiratory System criteria | |||
| Benzodiazepines with acute or chronic respiratory failure | 1 | 0 | 0 |
| Musculoskeletal System criteria | |||
| NSAID with established hypertension or heart failure | 7 | 6 | 6 |
| Long-term use of NSAID for symptom relief of osteoarthritis pain where paracetamol has not been tried | 1 | 1 | 1 |
| Long-term corticosteroids as monotherapy for rheumatoid arthritis | 3 | 0 | 0 |
| COX-2 selective NSAIDs with concurrent cardiovascular disease | 3 | 2 | 2 |
| NSAID with concurrent corticosteroids without PPI prophylaxis | 1 | 0 | 0 |
| Oral bisphosphonates in patients with a history of upper gastrointestinal disease | 1 | 1 | 1 |
| Urogenital System criteria | |||
| Antimuscarinic drugs for overactive bladder syndrome with concurrent dementia or chronic cognitive impairment or narrow-angle glaucoma, or chronic prostatism | 3 | 3 | 2 |
| Endocrine System criteria | |||
| Sulphonylureas with a long duration of action with type 2 diabetes mellitus | 16 | 4 | 4 |
| Beta-blockers in diabetes mellitus with frequent hypoglycaemic episodes | 1 | 0 | 0 |
| Drugs that predictably increase the risk of falls in older people | |||
| Benzodiazepines | 23 | 8 | 7 |
| Vasodilator drugs with persistent postural hypotension | 22 | 7 | 7 |
| Hypnotic Z-drugs | 9 | 2 | 2 |
| Antimuscarinic/anticholinergic drug burden | |||
| Concomitant use of two or more drugs with antimuscarinic/anticholinergic properties | 2 | 1 | 1 |
| STOPP-J | 74 | 21 | 21 |
| Sulpiride | 3 | 1 | 1 |
| H2 receptor antagonists | 32 | 12 | 12 |
| Laxative magnesium oxide (decreased kidney function) | 23 | 8 | 8 |
| α-glucosidase inhibitors | 15 | 0 | 0 |
| SGLT2 inhibitors | 1 | 0 | 0 |
Abbreviations: ACE angiotensin-converting enzyme, COX-2 cyclooxygenase-2, eGFR estimated glomerular filtration rate, NSAID non-steroidal anti-inflammatory drug, PPI proton-pump inhibitors, SGLT2 sodium-glucose transporter 2, STOPP-v2 Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria version 2, STOPP-J Screening Tool for Older Persons’ Appropriate Prescriptions for Japanese
aList of drugs includes only PIMs detected during the study period
bThe criterion of “Benzodiazepines for ≥4 weeks” included both benzodiazepines and hypnotic Z-drugs