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Table 4 Selected Prescribing Criteria/Prescribing Indicator [16]

From: ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people

Criteria Concern Estimated prevalence in Irelanda
PPI for peptic ulcer disease at full therapeutic dosage for > 8 weeks Earlier discontinuation or dose reduction for maintenance/ prophylactic treatment of peptic ulcer disease, oesophagitis or GORD indicated 4.1- 16.7 %
NSAID (>3 months) for relief of mild joint pain in osteoarthritis Simple analgesics preferable and usually as effective for pain relief 1.1 - 8.8 %
Long-term (i.e. >1 month), long-acting benzodiazepines e.g. chlordiazepoxide, flurazepam, nitrazepam, chlorazepate and benzodiazepines with long-acting metabolites e.g. diazepam Risk of prolonged sedation, confusion, impaired balance, falls 3.0-9.1 %
Any regular duplicate drug class prescription e.g. 2 concurrent opiates, NSAIDs, SSRIs, loop diuretics, ACE inhibitors. Excludes duplicate prescribing of drugs that may be required on a PRN basis e.g. Inhaled beta 2 agonists (long and short acting) for asthma or COPD, and opiates for management of breakthrough pain Optimisation of monotherapy within a single drug class should be observed prior to considering a new class of drug 2.2 – 6.0 %
TCAs with an opiate or calcium channel blocker Risk of severe constipation 0.4-2.0 %
Aspirin at dose >150 mg/day Increased bleeding risk, no evidence for increased efficacy 0.1-1.%
Theophylline as monotherapy for COPD/Asthma Risk of adverse effects due to narrow therapeutic index 0.6-1.2 %
Use of aspirin and warfarin in combination without histamine H2 receptor antagonist or PPI high risk of GI bleeding 0.3-1.1 %
Doses of short-acting benzodiazepines, doses greater than: lorazepam 3 mg; oxazepam 60 mg; alprazolam 2 mg; temazepam 15 mg; and triazolam 0.25 mg Total daily doses should rarely exceed the suggested maximums 1.0-1.5 %
Prolonged use (>1 week) of first generation antihistamines i.e. diphenydramine, chlorpheniramine, cyclizine, promethazine Risk of sedation and anticholinergic side effects <1.0 %
Warfarin and NSAID together Risk of GI bleeding 0.7-1.7 %
Calcium channel blockers with chronic constipation May exacerbate constipation <1.0 %
NSAID with history of peptic ulcer disease or GI bleeding, unless with concurrent histamine H2 receptor antagonist, PPI or misoprostol Risk of peptic ulcer relapse <1.0 %
Bladder antimuscarinic drugs with dementia Risk of increased confusion, agitation <1.0 %
TCAs with constipation May worsen constipation <1.0 %
Digoxin at a long-term dose > 125 μg/day (with impaired renal function) Increased risk of toxicity <1.0 %
<1.0 %
Thiazide diuretic with a history of gout May exacerbate gout <1.0 %
Glibenclamide (with type 2 diabetes mellitus) Risk of prolonged hypoglycaemia <1.0 %
Aspirin with a past history of peptic ulcer disease without histamine H2 receptor antagonist or PPI Risk of bleeding <1.0 %
Prochlorperazine or metoclopramide with Parkinsonism Risk of exacerbating Parkinsonism <1.0 %
TCAs with dementia Risk of worsening cognitive impairment <1.0 %
TCAs with glaucoma Likely to exacerbate glaucoma <1.0 %
TCAs with cardiac conductive abnormalities Pro-arrhythmic effects <1.0 %
Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthritis or osteoarthritis Risk of major systemic corticosteroid side-effects <1.0 %
Bladder antimuscarinic drugs with chronic prostatism Risk of urinary retention <1.0 %
NSAID with heart failure Risk of exacerbation of heart failure <1.0 %
TCAs with prostatism or prior history of urinary retention Risk of urinary retention <1.0 %
Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in COPD/Asthma Unnecessary exposure to long-term side-effects systemic steroids <1.0 %
Bladder antimuscarinic drugs with chronic glaucoma Risk of acute exacerbation of glaucoma <0.01 %
NSAID with SSRI Increased risk of GI bleed N/A
Bladder antimuscarinic drugs with chronic constipation Risk of exacerbation of constipation N/A
Prednisolone (or equivalent) > 3 months or longer without bisphosphonate Increased risk of fracture N/A
NSAID with ACE-inhibitor Risk of kidney failure, particularly if presence of general arteriosclerosis, dehydration or concurrent use of diuretics N/A
NSAID with diuretic May reduce the effect of diuretics and worsen existing heart failure N/A
  1. Abbreviations – ACEI angiotensin-converting-enzyme inhibitor, COPD chronic obstructive pulmonary disease, GI gastro-intestinal, NA not available, GORD gastro-oesophageal reflux disease, NSAID Nonsteroidal anti-inflammatory drug, PPI Proton Pump Inhibitor, PRN Pro re nata, as needed, SSRI Selective serotonin reuptake inhibitor, TCA Tricyclic Anti-depressant
  2. aPrevalence – the proportion of the study population with 1 or more potentially inappropriate medications from the literature