Gallagher et al used the STOPP (Screening Tool of Older Person's Prescriptions) to help guide therapy in older adults. There were several general principles that can be used when planning therapy. The authors are from Cork University in Ireland.
Patient selection: age >= 65 years
Problem
Issue
long-term use
some drugs best restricted to short-term use in the elderly
safer alternative
better to use a drug that is safer
narrow therapeutic index
a drug with a narrow therapeutic index may be difficult to control
more effective alternative
better to use a drug that is more efficacious
use of duplicate drug classes having the same effect
usually better to optimize therapy within a single drug class before introducing a second (exceptions: additive effects, lower risk of side effects)
make a comorbid condition worse
select an alternative that does not make the comorbid condition worse, or prescribe with another drug that reduces the risk
adverse interaction with another drug
select a drug that does not interact with other drugs
altered kinetics due to comorbid condition, especially impaired renal function
select either a safer drug or a drug less affected by comorbid condition
drug not indicated for patient's problem
every drug prescribed should have a clear indication for use
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