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Adverse Drug Reactions in Elderly Subjects Hospitalized in a Specialized Dementia Management Unit

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Abstract

Introduction

Drug prescriptions represent an actionable item in the prevention of adverse drug reactions (ADRs). The aims of this study were to identify risk factors for the occurrence of ADRs, and to describe symptoms and drug interactions.

Methods

This was a longitudinal study over a period of 19 months in an acute geriatric ward specializing in the management of dementia. Independent risk factors for ADRs were identified by logistic regression. Drug interactions were also recorded.

Results

In total, 293 patients were included (age 82 ± 8 years). The prevalence of ADRs was 24 %. Patients were taking 8 ± 3 drugs per day; 72 (24.6 %) were taking more than three psychotropics. The main therapeutic classes prescribed were anxiolytics and hypnotics (57.7 %), antidementia drugs (54.6 %), antidepressants (54.3 %), antithrombotics (54.0 %), angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin II receptor blockers [ARBs] (37.5 %). The risk of ADRs was significantly higher in patients taking neuroleptics (odds ratio [OR] 2.04; 95 % confidence interval [CI] 1.06–3.92), ACEIs/ARBs (OR 2.07; 95 % CI 1.13–3.77) and antidementia drugs (OR 1.84; 95 % CI 1.01–3.36). The risk of serious ADRs was significantly higher in patients taking ACEIs/ARBs (OR 2.95; 95 % CI 1.40–6.21), type I, III or IV antiarrhythmics (OR 2.71; 95 % CI 1.07–6.88) or neuroleptics (OR 2.42; 95 % CI 1.09–5.40). Drug interactions were involved in 26.3 % (n = 21) of ADRs; the combination of an ADR plus a drug interaction was associated with increased severity (p = 0.02).

Conclusion

Caution is needed when prescribing ACEIs/ARBs, neuroleptics, antidementia drugs, or certain types of antiarrhythmics in patients suffering from dementia. Psychotropics should be avoided because of the associated risk of ADRs and drug interactions.

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Acknowledgments

The authors thank Fiona Ecarnot (EA3920, Department of Cardiology, University Hospitals of Besançon, France) for translation and editorial assistance.

Lukshe Kanagaratnam, Rachid Mahmoudi, Jean-Luc Novella, Damien Jolly, Moustapha Dramé and Thierry Trenque declare no conflicts of interest.

No sources of funding were used to assist in the conduct of this study or the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Reims, France

    Lukshe Kanagaratnam & Thierry Trenque

  2. Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France

    Rachid Mahmoudi, Jean-Luc Novella, Damien Jolly, Moustapha Dramé & Thierry Trenque

  3. Department of Geriatrics and Internal Medicine, Reims University Hospitals, Reims, France

    Rachid Mahmoudi & Jean-Luc Novella

  4. Department of Research and Innovation, Reims University Hospitals, Reims, France

    Damien Jolly & Moustapha Dramé

Authors
  1. Lukshe Kanagaratnam
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Correspondence to Thierry Trenque.

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Kanagaratnam, L., Mahmoudi, R., Novella, JL. et al. Adverse Drug Reactions in Elderly Subjects Hospitalized in a Specialized Dementia Management Unit. Drugs Aging 31, 769–776 (2014). https://doi.org/10.1007/s40266-014-0206-0

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