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According to China's seventh population census released in 2021, the population aged 65 and above reached 190 million, accounting for 13.
5% of China's
total population.
The multi-disease coexistence of the elderly population aged 65 and above in the world is also very serious, with a prevalence rate of 40%~56%, and the coexistence of multiple diseases leads to multiple medications, and the higher the proportion of reuse of drugs at the age of
most.
Multi-medication in frail older adults is associated with increased serious adverse events (falls, cognitive dysfunction, functional decline, prolonged hospital stay, and risk of rehospitalization and death), and the issue of safe medication for this special population needs clinical attention
.
Recently, the "Chinese Expert Consensus on the Safety Management of Multimedication in the Frail Elderly in Integrated Medical and Nursing Care Institutions (2022 Edition)" was released in the Chinese Journal of Cardiovascular Disease, aiming to guide the early screening, assessment, management and individualized comprehensive intervention
of adverse reactions caused by multiple medication in the frail elderly in integrated medical and nursing care institutions.
Regarding the use of endocrine metabolism/nutritional drugs in the frail elderly, the consensus mainly puts forward the following safety warnings
.
Safety warning for the use of "endocrine-metabolic/nutritional drugs" in the frail elderly
First, glucocorticoids
➤In combination with antipyretic and anti-inflammatory analgesics (such as aspirin, indomethacin, ibuprofen, etc.
) to increase the risk of peptic ulcer and gastrointestinal bleeding;
➤ In combination with anti-epileptic drugs, it can reduce the effect of glucocorticoids;
➤ Combined with oral hypoglycemic drugs and insulin to weaken the hypoglycemic effect;
➤ In combination with testosterone and methyltestosterone, it increases the risk of edema;
➤ Combined with digitalis drugs to increase the risk of digitalis poisoning;
➤ In combination with potassium-excreting diuretics (furosemide, torasemide, hydrochlorothiazide, etc.
), it can lead to severe hypokalemia;
➤In combination with antibiotic aminoglycosides, the effect of glucocorticoids is weakened;
➤In combination with metronidazole, the antibacterial effect is weakened;
➤ In combination with antifungal drugs, fungal can spread, hypokalemia and liver damage
occur.
Second, thyroid disease medication
levothyroxine:
➤Combined with hypoglycemic drugs (metformin, glittas and insulin), it can weaken the hypoglycemic effect;
➤Combined with dicoumarin and warfarin, enhance anticoagulant effect, easy to cause bleeding;
➤ In combination with aspirin, salicylic acid, furosemide, phenytoin, carbamazepine, free thyroxine levels increase;
➤ In combination with amiodarone and iodine-containing preparations, it affects thyroid function;
➤ In combination with the antidepressant sertraline, it can reduce the effect of levothyroxine;
Thyroxine preparations:
➤ Simultaneous administration with calcium preparations can reduce the absorption of gastrointestinal thyroxine and affect the efficacy
.
methimazole:
➤ In combination with anticoagulants (heparin, warfarin, rivaroxaban, atragia, dabigatran etexilate, etc.
), the risk of bleeding increases;
➤ In combination with sulfonylurea hypoglycemic drugs (glibenclamide, bengliclide, etc.
) and antipyretic analgesics (p-aminosalicylic acid, phenylbutazone, etc.
), it can inhibit thyroid function
Third, hypoglycemic drugs
Insulin:
➤In combination with glucocorticoids, phenytoin, thiazides, etc.
, the hypoglycemic effect is weakened, and the amount of insulin needs to be increased;
➤Combined with methotrexate, anticoagulants, sulfonamides, etc.
can enhance the effect of insulin and be prone to hypoglycemia;
➤ In combination with propranolol can mask signs of hypoglycemia and increase the risk of hypoglycemia;
➤ Increased risk of hypoglycemia in combination with aspirin
Long-acting sulfonylurea hypoglycemic agents (glibenclamide):
➤In combination with ACEI antihypertensive drugs, fluconazole, rifampicin, aspirin and other drugs, it can increase the risk of hypoglycemia and avoid being used in elderly patients
.
Repaglinide:
➤Combination with ACEI, clopidogrel, and gemfibrozil will prolong its metabolic time, which can aggravate the risk of hypoglycemia, and the combination of gemfibrozil
is prohibited.
Thiazolidinediones (pioglitazone, rosiglitazone):
➤ In combination with gemfibrozil, it can affect the time of expulsion and increase the risk of
heart failure.
Satagliptin:
➤Combined with strong inhibitors such as ketoconazole and atazanavir to increase the efficacy;
➤Combination with rifampicin CYP3A4/5 strong inducer to reduce efficacy;
Metformin:
➤ When used with iodine-containing contrast agent, it can affect the excretion of iodine-containing contrast agent from the kidney, and even cause kidney damage, so the application of iodine-containing contrast agent needs to stop metformin
according to relevant guidelines.
Fourth, lipid-lowering drugs
Statins:
➤Atorvastatin, simvastatin and amlodipine, ticagrelor, amiodarone, dronedarone, verapamil, diltiazole, itraconazole, ketoconazole, voriconazole, clarithromycin, erythromycin, telimycin, cyclosporine in combination, easy to cause rhabdomyolysis;
➤Simvastatin combined with imatinib and erlotinib has the risk of rhabdomyolysis;
➤Simvastatin combined with dabigatran etexilate increases the risk of hemorrhagic stroke, and follow-up observation needs to be strengthened;
➤Simvastatin and atorvastatin are taken with grapefruit juice (>1.
2L/d), slowing down the metabolism of statins and increasing the risk;
➤ In combination with fibrate drugs (felofibrate), it increases the risk of myolysis and is generally not suitable for combination, if it must be combined, it should be cautious and closely monitored;
Nicotinic acid:
➤ In combination with ganglion blockers, resulting in orthostatic hypotension;
➤ Combined with hypoglycemic drugs to reduce the effect
of hypoglycemia.
Note: When the frail elderly receive lipid-lowering drugs, it is recommended that the target value should be appropriately relaxed (LDL cholesterol≥ 1.
4mmol/L); Patients with cachexia tumors are not recommended for routine lipid-lowering therapy
except for sudden cardiovascular events.
5.
Other metabolic drugs
Colchicine:
➤Combination with clarithromycin increases the risk of rhabdomyolysis, renal failure, and acute neuromyopathy;
Allopurinol:
➤ In combination with azathioprine, it can cause bone marrow suppression, it is necessary to closely observe the general insufficiency of vitamin D in the elderly, and the active vitamin D is better than ordinary vitamin D3 according to the deficiency and demand, and it is not recommended to supplement vitamin D2 preparations
in the weakened elderly.
Reference: "Chinese Expert Consensus on the Safety Management of Multiple Drugs in the Weakened Elderly in Integrated Medical and Nursing Care Institutions (Edition)", Chinese Geriatrics Society Integrated Medical and Nursing Care Promotion Committee.
Chinese expert consensus on the safety management of multiple drugs in the frail elderly in integrated medical and nursing care institutions (2022 edition)[J].
Chinese Journal of Cardiovascular Disease,2022,27(5):403-410.
