Potentially inappropriate medications in the elderly: the PRISCUS list.
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.
Holt
Stefanie
S
Klinische Pharmakologie, Private Universität Witten/Herdecke gGmbH, Wuppertal, Germany.
Schmiedl
Sven
S
Thürmann
Petra A
PA
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*
Eur J Clin Pharmacol. 2008 Feb;64(2):183-99
18180915
BMJ. 2008 Mar 15;336(7644):606-9
18340075
Exp Gerontol. 2004 Nov-Dec;39(11-12):1731-8
15582289
Exp Gerontol. 2003 Aug;38(8):843-53
12915206
BMJ. 1996 Jan 13;312(7023):71-2
8555924
Eur J Clin Pharmacol. 2007 Aug;63(8):725-31
17554532
N Engl J Med. 1987 Feb 12;316(7):363-9
2880292
Consult Pharm. 2009 Aug;24(8):601-10
19689175
Scand J Prim Health Care. 2009;27(3):153-9
19462339
Br J Clin Pharmacol. 2004 Jan;57(1):6-14
14678335
Ann Pharmacother. 2007 Mar;41(3):438-47
17311835
J Clin Psychiatry. 1999;60 Suppl 20:4-8
10513851
Eur J Clin Pharmacol. 2003 Nov;59(8-9):637-44
12923602
Lancet. 2007 Jul 14;370(9582):173-184
17630041
Arch Intern Med. 2009 Jul 27;169(14):1326-32
19636035
J Clin Psychiatry. 1990 Dec;51 Suppl B:28-33
2258379
JAMA. 2005 Mar 16;293(11):1348-58
15769968
BMJ. 1995 Aug 5;311(7001):376-80
7640549
J Clin Pharm Ther. 2007 Apr;32(2):113-21
17381661
J Am Geriatr Soc. 2001 Feb;49(2):200-9
11207875
BMC Geriatr. 2009 Jan 28;9:5
19175914
J Gerontol. 1983 Jan;38(1):31-5
6129272
Clin Pharmacol Ther. 2009 Jan;85(1):94-7
18987619
Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
18218287
Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
14662625
Int J Geriatr Psychiatry. 2004 Aug;19(8):754-62
15290699
Am J Med. 1997 Dec;103(6):529-35
9428837
J Am Geriatr Soc. 2002 Dec;50(12):1962-8
12473007
Eur J Clin Pharmacol. 2002 Jul;58(4):285-91
12136375
Am J Psychiatry. 1971 Jul;128(1):95-9
5155625
BMC Geriatr. 2009 Jul 23;9:30
19627577
Arch Intern Med. 1997 Jul 28;157(14):1531-6
9236554
CMAJ. 1997 Feb 1;156(3):385-91
9033421