Thomas D - Comparison <strong>of</strong> days lost due to disability and Karn<strong>of</strong>sky performance status in burden <strong>of</strong> dicl<strong>of</strong>enac induced adverse drug reactionshttp://www.nature.com/ki/journal/v57/n74s/full/4491632a.html(Accessed on June, 1, <strong>2012</strong>).5. Wilkerson L and Blacketer TM. Reducing the burden <strong>of</strong> adversedrug events. The Kentucky Pharmacist May <strong>2012</strong>; 34-38.6. Chawla S, Kalra BS, Dharmshaktu P and Sahni P. Adversedrug reaction monitoring in a tertiary care teaching hospital. JPharmacol Pharmacother 2011; 2(3):196-198.7. Elghuel Abdulbaset. The characteristics <strong>of</strong> adults with uppergastrointestinal bleeding admitted to Tripoli Medical Center: aretrospective case-series analysis. Libyan J Med 2011, 6:6283, available at: www.ajol.info/index.php/ljm/article/download/ 70650/59248 (Accessed on May, 28, <strong>2012</strong>).<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 5 Issue 3 <strong>Jul</strong> - <strong>Sep</strong>, <strong>2012</strong> 39
<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>Association <strong>of</strong> Pharmaceutical Teachers <strong>of</strong> IndiaThe Prevalence <strong>of</strong> Polypharmacy in South <strong>Indian</strong> Patients:A Pharmacoepidemiological Approach.Mohammed S.S*, Sreenath.M.K, Vishnu V.G, Jose F, Siraj S.T, Anand V.P.R.*<strong>Pharmacy</strong> Coordinator & Adjunct Faculty, School <strong>of</strong> <strong>Pharmacy</strong>, Gulf Medical University, Ajman, UAE.Department <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>, JSS College <strong>of</strong> <strong>Pharmacy</strong>, JSS University, Rocklands, Ooty, Nilgiris, India – 643001A B S T R A C TSubmitted: 26/06/<strong>2012</strong>Accepted: 12/09/<strong>2012</strong>The study conducted assessed the prevalence <strong>of</strong> polypharmacy and identified the individuals particularly at risk <strong>of</strong> polypharmacy.Data collectionwas based on the prescriptions collected from patient's hospital records and case sheets. The collected prescriptions were scrutinized forpolypharmacy and were categorized as minor polypharmacy - concurrent use <strong>of</strong> 2 to 4 drugs; and major polypharmacy – concurrent use <strong>of</strong> five ormore drugs. Out <strong>of</strong> 1003 prescriptions 630 prescriptions were found to be minor polypharmacy and 373 prescriptions were majorpolypharmacy.The results showed that major polypharmacy was more prevalent among the cardiovascular diseases (31.5%) followed by the infectiousdiseases (23.67%) and was seen to be least in dermatological diseases (0.67 %); the minor polypharmacy was prevalent in gastrointestinaldisorders (24.07 %) followed by the infectious diseases (20.10 %) and least in dermatological diseases (1.74 %).Based on the informationobtained from our study suggestions to reduce the polypharmacy related problemsare as follows: Ask patients to bring all medicines to counselingcenter ; Control pro re nata prescribing; Select a drug that have more than one indication; Start with low doses and titrate dose according to effect;Monitor for adverse reactions and check for potential drug interactions; Routinely check and encourage compliance; Periodically simplify thetherapeutic regimen and stop drugs if possible; Educate the patient about the drug therapy and teach the patient to prioritize the currently useddrugs; Place limits on the duration <strong>of</strong> drug prescribing.Keywords: Polypharmacy, Drug therapy, Drug utilization, Prescribing pattern.INTRODUCTIONPolypharmacy is the use <strong>of</strong> several drugs or medicinestogether in the treatment <strong>of</strong> disease, suggestingindiscriminate, unscientific, or excessive prescription.Polypharmacy is defined as a condition in which a patientreceives too many drugs for too long time, or drug in1exceedingly high doses <strong>of</strong>ten result. The unavoidableconsequence is that increasingly frail patients are being2treated with Polypharmacy. Chesteret al have mentioned thatthere is no consistent definition for polypharmacy in theliterature and that many authors define it simply as the use <strong>of</strong>3five or six medications. However polypharmacy is muchmore complex than just the number <strong>of</strong> medication a patient4,5uses. Polypharmacy may be appropriate if all drugs in theregimen address recognized indications or inappropriate ifmore drugs prescribed than necessary, drugs withunacceptable side effects or toxicity prescribed, either whenused alone or in combination with other medications in theregimen, or redundant drugs prescribed.Address for Correspondence:Dr. Mohammed Saji S, <strong>Pharmacy</strong> Coordinator & Adjunct Faculty, School <strong>of</strong><strong>Pharmacy</strong>, Gulf Medical University, Ajman, UAE.E-mail: drmohdsaji@gmail.comPolypharmacy in a managed care setting presents a unique set6<strong>of</strong> challenges and opportunities. Intervention to reducepolypharmacy must address several issues such asappropriate medication usage in elderly, including theappropriateness indication, drug-drug duplication in the sameclass <strong>of</strong> therapeutics, inappropriate and complex dosing,drug-drug interaction, drug disease interaction, drug foodinteraction, coordination <strong>of</strong> the medication between primarycare provider and specialists, use <strong>of</strong> drug holidays, andeducation <strong>of</strong> member regarding adverse drug effects and other7issues related to compliance.There are many potential risks associated with polypharmacy.When several medications are used simultaneously, there isan increased risk <strong>of</strong> drug-drug interactions and adverse drug8reactions. Epidemiological studies <strong>of</strong> risk factors for adversedrug reactions have shown that the number <strong>of</strong> concurrentlyused drugs is the most important predictor <strong>of</strong> these9complications.Polypharmacy increases the risk <strong>of</strong> hospitalizations, and10,11medication errors. These factors eventually lead toincreased patient costs, non-adherence to treatment,12, 13increased rate <strong>of</strong> patient morbidity and mortality.Studies from many countries have shown that a<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 5 Issue 3 <strong>Jul</strong> - <strong>Sep</strong>, <strong>2012</strong> 40
Change language