Gallagher et al used the STOPP (Screening Tool of Older Person's Prescriptions) to help guide therapy in older adults. Psychotropic and central nervous system (CNS) drugs are an important cause of adverse side effects in this population. The authors are from Cork University in Ireland.
Patient selection: age >= 65 years
|
Drug |
Comorbid |
Other |
Adverse Effect |
|
TCA |
dementia |
|
cognitive impairment |
|
TCA |
glaucoma |
|
worsen glaucoma |
|
TCA |
cardiac conductive abnormality |
|
pro-arrhythmic action |
|
TCA |
constipation |
|
worsen constipation |
|
TCA |
|
with opiate or calcium channel blocker |
worsen constipation |
|
TCA |
BPH, urinary retention |
|
worsen urinary retention |
|
benzodiazepine, long-acting |
|
prolonged use (> 1 month) |
sedation, confusion, falls |
|
neuroleptic |
|
prolonged use (> 1 month) as hypnotic |
confusion, falls, hypotension, extra-pyramidal effects |
|
neuroleptic |
Parkinson's disease |
prolonged use (> 1 month) |
worsen extra-pyramidal symptoms |
|
phenothiazines |
epilepsy |
|
lower seizure threshold |
|
anticholinergic drug |
extrapyramidal side effects of neuroleptic drug |
|
anti-cholinergic effect |
|
SSRI |
hyponatremia within past 2 months |
|
|
|
first generation antihistamine |
|
prolonged use (> 1 week) |
sedation, anti-cholinergic effect |
where:
• TCA = tricyclic antidepressant
• SSRI = selectie serotonin re-uptake inhibitors
• First-generation antihistamine = diphenhydramine, chlorpheniramine, cyclizine, promethazine
• Hyponatremia = < 130 mmol/L
• BPH = benign prostatic hypertrophy
Specialty: Pharmacology, clinical
