Polypharmacy and Medicines to Avoid



The number of individuals surviving past age 65 is increasing globally and the likelihood of suffering from chronic diseases is also rising as the demographics shift. Since even a single medical condition may require multiple medications, it is not surprising that each additional disease significantly increases the risk for polypharmacy-related adverse drug reactions (ADRs) and morbidity. This is especially so when each comorbidity requires the care of a different specialist as is frequently seen in the aged population.


Neuropathic Pain Herpes Zoster Anticholinergic Effect Postoperative Delirium Beers Criterion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author wishes to thank Andrea Gomez, MD and Mary-Rita Blute, RN for their assitance during the preparation of this chapter.

Suggested Reading

  1. Ament PW, Bertolino JG, Liszewski JL. Clinically significant drug interactions. Am Fam Physician. 2000;61:1745–1754.PubMedGoogle Scholar
  2. Argoff CE. Clinical implications of opioid pharmacogenetics. Clin J Pain. 2010;26:S16–S20.PubMedCrossRefGoogle Scholar
  3. Barnett, SR. Polypharmacy and perioperative medications in the elderly. Anesthesiol Clin. 2009;27(3):377–389.PubMedCrossRefGoogle Scholar
  4. Budnitz DS, Pollock DA, Weidenback KN, et al. National surveillance of emergency department visits for outpatients adverse drug events. JAMA. 2006;296:1858–1866.PubMedCrossRefGoogle Scholar
  5. Cadieux RJ. Antidepressant drug interactions in the elderly. Postgrad Med. 1999;106:231–249.PubMedCrossRefGoogle Scholar
  6. Carnahan RM, Lund BC, Perry PJ, et al. The concurrent use of anticholinergics and cholinesterase inhibitors; rare event or common practice? J Am Geriatr Soc. 2004;52:2082–2087.PubMedCrossRefGoogle Scholar
  7. Confere T, Sprung J, Kumar MM, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg. 2005;100:636–644.CrossRefGoogle Scholar
  8. de Abajo FJ, Garcia–Rodriguez LA. Risk of upper gastrointestinal track bleeding associated with selective serotonin reuptake inhibitors and venlafaxine, therapy: interaction with non–steroidal anti–inflammatory drugs and effect of acid–suppressing agents. Arch Gen Psychiatry. 2008;65;795–803.PubMedCrossRefGoogle Scholar
  9. Egger SS, Rätz Bravo AE, Hess L, et al. Age-related differences in the prevalance of potential drug-drug interactions in ambulatory dyslipidemic patients treated with statins. Drugs Aging. 2007;24:429–40.PubMedCrossRefGoogle Scholar
  10. Fick DM, Cooper JW, Wade WE, Waller JL, Mc. Lean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med. 2003;163: 2716–2724.PubMedCrossRefGoogle Scholar
  11. Heaver JF. Polypharmacy. In: Sieber, FE, ed. Geriatric anesthesia. The McGraw–Hill Companies, Inc; 2007:163–172.Google Scholar
  12. Haanpaa ML, Gourlay GK, Kent JL. Treatment considerations for patients with neuropathic pain, and other medical comorbidities. Mayo Clin Proc. 2010;85:S15–S28.PubMedCrossRefGoogle Scholar
  13. Hayes BD, Klein–Schwartz W, Barrueto F. Polypharmacy and the geriatric patient. Clin Geriatr Med. 2007;23:371–390.PubMedCrossRefGoogle Scholar
  14. Inonye SK. Delirium in older persons. N Engl.J.Med. 2006;354:1157–1165.CrossRefGoogle Scholar
  15. Jaillon P, Simon T. Genetic polymorphism of beta–adrenergic receptors and mortality in ischemic heart disease. Therapie. 2007;62:1–7.PubMedCrossRefGoogle Scholar
  16. Johnson EM, Whyte E, Mulsant BH, et al. Cardiovascular changes associated with venlafaxine in the treatment of late–life depression. Am J Geriatr Psychiatry. 2006;14:796–802.PubMedCrossRefGoogle Scholar
  17. Jones PM, Soderman RM. Intraoperative bradycardia in a patient with Alzheimer’s disease treated with two cholinesterase inhibitors. Anaesthesia. 2007;62:109–204.CrossRefGoogle Scholar
  18. Kleinsasser A, Loeckinger A, Lindner KH et al. Reversing sevofluorane–associated Q–Tc prolongation by changing to propofol. Anesthesia. 2001;56:248–250.CrossRefGoogle Scholar
  19. Lyrica(Pregabalin)[package insert].New York, NY:Pfizer;2006.Google Scholar
  20. Moitra V, Diaz G, Sladen RN. Monitoring hepatic function. In Fleisher LA, cons.ed: Anesthesiology Clin: monitoring. WB. Saunders Inc. 2006;24:857–880.Google Scholar
  21. Pats MT, Costa–Lima B, Monette J, et al. Medications problems in older, newly diagnosed cancer patients in Canada; how common are they? Drugs Aging. 2009;26(6):519–536.CrossRefGoogle Scholar
  22. Qato DM, Alexander GC, Conti RM, et al. Use of prescription and over the counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.PubMedCrossRefGoogle Scholar
  23. SFINX drug interactions. http://www.terveysportti.%01/s%01nx/.
  24. Shi S, Morihe K, Klotz U. The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol. 2008;64:183–199.PubMedCrossRefGoogle Scholar
  25. Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side effect management. J Clin Pharm Ther. 2007;32:169–175.PubMedCrossRefGoogle Scholar
  26. Stefanacci RC, Cavallaro E, Beers MH, et al. Developing explicit positive Beers criteria for preferred central nervous system medications in older adults. Consult Pharm. 2009;24:601–610.PubMedCrossRefGoogle Scholar
  27. Steinman MA, Landfeld CS, Rosenthal GE, et al. Polipharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54:1516–1523.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Anesthesiology and Critical Care MedicineJohns Hopkins Bayview Medical CenterBaltimoreUSA

Personalised recommendations