Gallagher et al used the STOPP (Screening Tool of Older Person's Prescriptions) to help guide therapy in older adults. An important category are those used for patients with cardiovascular disorders. The authors are from Cork University in Ireland.
Patient selection: age >= 65 years
Cardiovascular Drugs
Comorbid
Other
Adverse Effect
digoxin, long-term
impaired renal function
risk digoxin toxicity
thiazide
gout
exacerbation gout
non-cardio selective beta blocker
COPD
risk of bronchospasm
beta-blocker
with verapamil
risk of heart block
verapamil or diltiazem
NYHA class III or IV heart failure
worsening of heart failure
calcium channel blocker
constipation
worsening of constipation
aspirin
warfarin
without histamine H2 receptor antagonist (but not cimetidine) or PPI
risk for GI bleeding
aspirin
past history peptic ulcer disease
without histamine H2 receptor antagonist or PPI
risk of GI bleeding
aspirin, high dose (> 150 mg/day)
risk of bleeding without evidence of efficacy
aspirin
bleeding disorder
bleeding
warfarin
bleeding disorder
bleeding
clopidogrel
bleeding disorder
bleeding
dipyridamole
bleeding disorder
bleeding
Drug
Reason
dipyridamole
cardiovascular disease secondary prevention
no evidence of efficacy
aspirin
prevent coronary or peripheral vascular disease without history of
no evidence of efficacy
aspirin
dizziness not due to cerebrovascular disease
not indicated
warfarin for more than 6 months
first uncomplicated DVT
no added benefit
warfarin for more than 12 months
first uncomplicated pulmonary embolism
no proven benefit
loop diuretic
dependent ankle edema without heart failure
not indicated, compression hosiery should be used
loop diuretic monotherapy
hypertension
better alternatives
where:
• Cimetidine may interact with warfarin.
• PPI = proton pump inhibitor
• DVT = deep vein thrombosis
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