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
Specialty: Pharmacology, clinical