Interações medicamentosa e polifarmárcia em pacientes com déficit cognitivo
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2024.213793Palavras-chave:
Demência, Disfunção cognitiva, Interações medicamentosas, PolifarmáciaResumo
Pacientes com demência são mais propensos a utilizar múltiplos medicamentos, contribuindo para o aumento das interações medicamentosas. Este estudo teve como objetivo avaliar a frequência de casos de polifarmácia em pacientes com demência e determinar se o uso da calculadora digital é útil para identificar potenciais interações medicamentosas. Métodos: Trata-se de um estudo observacional retrospectivo. Os pacientes foram divididos pela presença ou ausência de polifarmácia. O grupo polifarmácia foi dividido em pacientes com demência e comprometimento cognitivo leve (CCL). As interações medicamentosas foram analisadas
pelo programa Lexicomp® (UpToDate) e estratificadas nos seguintes níveis: A (sem inte-ração), B (sem evidência de interação), C (benefícios potencialmente superiores aos riscos), D (considerar mudança de terapia), e X (riscos potencialmente superiores aos benefícios). Resultados: Dos 431 pacientes estudados, 78,4% apresentaram polifarmácia, com a idade influenciando significativamente esse achado (P=0,0053). A doença de Alzheimer foi a mais prevalente. No grupo polifarmácia, os pacientes com CCL eram mais jovens que aqueles com demência (P=0,032). As interações tipo C foram as mais prevalentes e não houve diferença nos tipos de interação entre os grupos estudados. Foram encontradas 1,5% de interações tipo X no grupo polifarmácia, sendo que a rivastigmina foi o principal medicamento responsável pelas interações medicamentosas. Conclusão: A polifarmácia ocorre em quatro em cada cinco pacientes com demência, sendo que os pacientes com doença de Alzheimer apresentam uma taxa significativamente maior de polifarmácia do que os pacientes com CCL. Além disso, a polifarmácia não influenciou os tipos de interação entre os grupos com e sem polifarmácia. O uso da calculadora ajudou a identificar potenciais interações entre os medicamentos nesse grupo de pacientes.
Downloads
Referências
World Health Organization. Dementia [Internet]. World Health Organization. World Health Organization: WHO; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022 18;5.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: A systematic review and metaanalysis. Alzheimer’s & Dementia. 2013;9(1):63-75.e2.
Rizzi L, Rosset I, Roriz-Cruz M. Global Epidemiology of Dementia: Alzheimer’s and Vascular Types. BioMed Research International [Internet]. 2014;2014:1–8.
Sakakibara M, Igarashi A, Takase Y, Kamei H, Nabeshima T. Effects of Prescription Drug Reduction on Quality of Life in Community-Dwelling Patients with Dementia. Journal of Pharmacy & Pharmaceutical Sciences. 2015;9;18(5):705.
World Alzheimer Report 2018 [Internet]. Available from: https://www.alzint.org/u/WorldAlzheimerReport2018.pdf.
Clague F, Mercer SW, McLean G, Reynish E, Guthrie B. Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of pri-mary care data. Age and Ageing. 2016;46(1):33-39.
Park H-Y, Park J-W, Song HJ, Sohn HS, Kwon J-W. The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Data-base in South Korea. Laks J, editor. PLOS ONE. 2017;5:12(1):e0169463.
Vetrano DL, Tosato M, Colloca G, Topinkova E, Fialova D, Gindin J, et al. Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study. Alzheimer’s & Dementia. 2012;9(5):587–93.
Green AR, Segal J, Tian J, Oh E, Roth DL, Hilson L, et al. Use of Bladder Antimuscarinics in Older Adults with Impaired Cognition. Journal of the American Geriatrics Society. 2016 7;65(2):390–4.
McCracken R, McCormack J, McGregor MJ, Wong ST, Garrison S. Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. BMJ Open. 2017;7(8):e017430.
Bunn F, Burn A-M, Goodman C, Rait G, Norton S, Robinson L, et al. Comorbidity and dementia: a scoping review of the literature. BMC Medicine. 2014;31;12:192.
Kuo T-C, Zhao Y, Weir S, Kramer MS, Ash AS. Implications of Comorbidity on Costs for Patients With Alzheimer Disease. Medical Care. 2008;46(8):839–46.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid Diseases: Implications for Pay for Performance. JAMA. 2005;294(6):716–24.
Parsons C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Therapeutic Advances in Drug Safety. 2016;8(1):31–46.
Hudhra K, Beçi E, Petrela E, Xhafaj D, García-Caballos M, Bueno-Cavanillas A. Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge. Journal of Evaluation in Clinical Practice. 2016;22(5):707–13.
Alomar MJ. Factors affecting the development of adverse drug reactions. Saudi Pharmaceuti-cal Journal. 2014;22(2):83–94.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety. 2013;13(1):57–65.
Patel RI, Beckett RD. Evaluation of resources for analyzing drug interactions. Journal of the Medical Library Association. 2016;104(4):290–5.
Martocchia A, Spuntarelli V, Aiello F, Meccariello AL, Proietta M, Del Porto F, et al. Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy. Drugs - Real World Outcomes. 2020;7(3):243–9.
Http://www.centrodememoriadecuritiba.com.br [Internet]. ricardokrause.. Available from: https://www.ricardo-krause.com/
Portet F. Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consorti-um on Alzheimer’s Disease. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(6):714–8.
Caramelli P, Teixeira AL, Buchpiguel CA, Lee HW, Livramento JA, Fernandez LL, et al. Diagnosis of Alzheimer’s disease in Brazil: Supplementary exams. Dementia & Neuropsycho-logia. 2011;5(3):167–77.
McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Insti-tute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia. 2011;7(3):263–9.
McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor J-P, Weintraub D, et al. Diagnosis and management of dementia with Lewy bodies. Neurology. 2017 Jun 7;89(1):88–100.
Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006–14.
Seeley WW. Behavioral Variant Frontotemporal Dementia. CONTINUUM: Lifelong Learning in Neurology. 2019;25(1):76–100.
Respondek G, Roeber S, Kretzschmar H, Troakes C, Al-Sarraj S, Gelpi E, et al. Accuracy of the national institute for neurological. disorders and stroke/society for progressive supranuclear palsy and neuroprotection and natural history in Parkinson plus syndromes criteria for the di-agnosis of progressive supranuclear palsy. Movement Disorders. 2013;28(4):504–9.
Melo SC de, Champs APS, Goulart RF, Malta DC, Passos VM de A. Dementias in Brazil: increasing burden in the 2000–2016 period. Estimates from the Global Burden of Disease Study 2016. Arquivos de Neuro-Psiquiatria. 2020;78(12):762–71.
Gareri P, Cotroneo AM, Pontieri MT, Palleria C, De Sarro G. The risk of polypharmacy and potentially inappropriate drugs in residential care dementia patients: tips from the PharE study. Aging Clinical and Experimental Research. 2020;33(7):1909–17.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety [Internet]. 2013;13(1):57–65.
Mesonero F, Fernández C, Sánchez-Rodríguez E, García-García Paredes A, Senosiain C, Albillos A, et al. Polypharmacy in Patients With Inflammatory Bowel Disease. Journal of Clinical Gastroenterology. 2021;56(3):e189–95.
O’Brien JT, Thomas A. Vascular dementia. The Lancet. 2015;386(10004):1698–706.
Souza RKM de, Barboza AF, Gasperin G, Garcia HDBP, Barcellos PM, Nisihara R. Prevalence of dementia in patients seen at a private hospital in the Southern Region of Brazil. Einstein (São Paulo). 2019;18:eAO4752.
Dening T, Sandilyan MB. Dementia: definitions and types. Nursing Standard. 2015;29(37):37–42.
Trevisan C, Limongi F, Siviero P, Noale M, Cignarella A, Manzato E, et al. Mild polypharma-cy and MCI progression in older adults: the mediation effect of drug–drug interactions. Ag-ing Clinical and Experimental Research. 2019;33(1):49–56.
Paulison B, Léos CL. Potential cardiotoxic reaction involving rivastigmine and beta-blockers: a case report and review of the literature. Cardiovascular Toxicology [Internet]. 2010;10(4):306–10.
Gill SS, Anderson GM, Fischer HD, Bell CM, Li P, Normand S-LT, et al. Syncope and Its Consequences in Patients With Dementia Receiving Cholinesterase Inhibitors: A Population-Based Cohort Study. Archives of Internal Medicine. 2009;169(9):867–73.
Kayrak M, Yazici M, Ayhan SS, Koc F, Ulgen MS. Complete atrioventricular block associated with rivastigmine therapy. American Journal of Health-System Pharmacy. 20081;65(11):1051–3.
Mims RB, Scott CL, Modebe O, Bethune JE. Inhibition of L-Dopa-Induced Growth Hormone Stimulation by Pyridoxine and Chlorpromazine. 1975. The Journal of Clinical En-docrinology & Metabolism. 1975;40(2):256–9.
Nozinan (methotrimeprazine) [product monograph] [Internet]. Laval, Quebec; 2020 [cited 2022 Jul 11]. Available from: https://products.sanofi.ca/en/nozinan.pdf
Namazi S, Kheshti R, Aalipour M. A comparison of five common drug–drug interaction software programs regarding accuracy and comprehensiveness. Journal of Research in Phar-macy Practice. 2016;5(4):257.
Shakeel F, Fang F, Kidwell KM, Marcath LA, Hertz DL. Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents. Journal of Oncology Pharmacy Practice. 2020;26(8):1843–9.
Kheshti R, Aalipour M, Namazi S. A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness. J Res Pharm Pract. 2016 ;5(4):257-263.
Nusair MB, Al-Azzam SI, Arabyat RM, Amawi HA, Alzoubi KH, Rabah AA. The prevalence and severity of potential drug-drug interactions among adult polypharmacy patients at outpa-tient clinics in Jordan. Saudi Pharmaceutical Journal. 2020;28(2):155–60.
Qerem WA, Bashir Jarrar Y, Sheikh IA, ElMaadani A. The prevalence of drug-drug interactions and polypharmacy among elderly patients in Jordan. Biomedical Research. 2018;29(12).
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Maruan Charkieh, Murilo Gadens, Urbano Martins Terceiro , Ricardo Martinez, Nelson Dal Santos, Renato Mitsunori Nisihara
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
