title: Potentially inappropriate medications in the elderly: the PRISCUS list.
abstract: BACKGROUND
  Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly because they carry an increased risk of adverse drug events in this patient group. PIM lists from other countries are of limited usefulness in Germany because different drugs are on the market in each country and prescribing practices vary as well. Thus, a list of potentially inappropriate medications for the elderly was developed specifically for use in Germany.
  
  
  METHODS
  A preliminary PIM list suitable for the German market was created on the basis of a selective literature search and a qualitative analysis of published international PIM lists. The final German PIM list was developed by means of a comprehensive, structured expert survey in two rounds (a so-called Delphi process).
  
  
  RESULTS
  83 drugs in a total of 18 drug classes were rated as potentially inappropriate for elderly patients. For 46 drugs, the experts came to no clear decision after the second Delphi round. For cases in which the administration of a PIM is clinically necessary, the final PRISCUS list contains recommendations for clinical practice, e.g. monitoring of laboratory values and dose adaptation. Therapeutic alternatives are also listed.
  
  
  CONCLUSIONS
  Potentially inappropriate medications carry the risk of causing adverse drug events in the elderly. A drawback of using a Delphi process to generate a PIM list, as was done for the new German list, is that little scientific evidence is currently available for the evaluation of active substances, potential therapeutic alternatives, and indicated monitoring procedures. Thus, the validity and practicability of the PRISCUS list remain to be demonstrated (and the same holds for PIM lists already published in other countries). It should be used as a component of an overall concept for geriatric pharmacotherapy in which polypharmacy and interacting medications are avoided, and doses are regularly re-evaluated.
authors.affiliation: Klinische Pharmakologie, Private Universität Witten/Herdecke gGmbH, Wuppertal, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Holt
authors.forename: Sven
authors.initials: S
authors.lastname: Schmiedl
authors.forename: Petra A
authors.initials: PA
authors.lastname: Thürmann
mesh_terms: D000369:Aged, 80 and over; D005853:Geriatrics / Q000592:standards*; D005858:Germany; D006801:Humans; D057970:Inappropriate Prescribing / Q000145:classification* / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*
references.citation: Eur J Clin Pharmacol. 2008 Feb;64(2):183-99
references.pmid: 18180915
references.citation: BMJ. 2008 Mar 15;336(7644):606-9
references.pmid: 18340075
references.citation: Exp Gerontol. 2004 Nov-Dec;39(11-12):1731-8
references.pmid: 15582289
references.citation: Exp Gerontol. 2003 Aug;38(8):843-53
references.pmid: 12915206
references.citation: BMJ. 1996 Jan 13;312(7023):71-2
references.pmid: 8555924
references.citation: Eur J Clin Pharmacol. 2007 Aug;63(8):725-31
references.pmid: 17554532
references.citation: N Engl J Med. 1987 Feb 12;316(7):363-9
references.pmid: 2880292
references.citation: Consult Pharm. 2009 Aug;24(8):601-10
references.pmid: 19689175
references.citation: Scand J Prim Health Care. 2009;27(3):153-9
references.pmid: 19462339
references.citation: Br J Clin Pharmacol. 2004 Jan;57(1):6-14
references.pmid: 14678335
references.citation: Ann Pharmacother. 2007 Mar;41(3):438-47
references.pmid: 17311835
references.citation: J Clin Psychiatry. 1999;60 Suppl 20:4-8
references.pmid: 10513851
references.citation: Eur J Clin Pharmacol. 2003 Nov;59(8-9):637-44
references.pmid: 12923602
references.citation: Lancet. 2007 Jul 14;370(9582):173-184
references.pmid: 17630041
references.citation: Arch Intern Med. 2009 Jul 27;169(14):1326-32
references.pmid: 19636035
references.citation: J Clin Psychiatry. 1990 Dec;51 Suppl B:28-33
references.pmid: 2258379
references.citation: JAMA. 2005 Mar 16;293(11):1348-58
references.pmid: 15769968
references.citation: BMJ. 1995 Aug 5;311(7001):376-80
references.pmid: 7640549
references.citation: J Clin Pharm Ther. 2007 Apr;32(2):113-21
references.pmid: 17381661
references.citation: J Am Geriatr Soc. 2001 Feb;49(2):200-9
references.pmid: 11207875
references.citation: BMC Geriatr. 2009 Jan 28;9:5
references.pmid: 19175914
references.citation: J Gerontol. 1983 Jan;38(1):31-5
references.pmid: 6129272
references.citation: Clin Pharmacol Ther. 2009 Jan;85(1):94-7
references.pmid: 18987619
references.citation: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references.pmid: 18218287
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references.pmid: 14662625
references.citation: Int J Geriatr Psychiatry. 2004 Aug;19(8):754-62
references.pmid: 15290699
references.citation: Am J Med. 1997 Dec;103(6):529-35
references.pmid: 9428837
references.citation: J Am Geriatr Soc. 2002 Dec;50(12):1962-8
references.pmid: 12473007
references.citation: Eur J Clin Pharmacol. 2002 Jul;58(4):285-91
references.pmid: 12136375
references.citation: Am J Psychiatry. 1971 Jul;128(1):95-9
references.pmid: 5155625
references.citation: BMC Geriatr. 2009 Jul 23;9:30
references.pmid: 19627577
references.citation: Arch Intern Med. 1997 Jul 28;157(14):1531-6
references.pmid: 9236554
references.citation: CMAJ. 1997 Feb 1;156(3):385-91
references.pmid: 9033421