Drugs ID'd in Most Older Adult Emergency Hospitalizations

Warfarin, insulin, oral antiplatelets, hypoglycemics implicated in most emergency hospitalizations

27 nov 2011-- Adverse drug events from commonly used medications, including warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents, account for the majority of emergency hospitalizations in older adults in the United States, according to a study published in the Nov. 24 issue of the New England Journal of Medicine.

Daniel S. Budnitz, M.D., M.P.H., from the Division of Healthcare Quality Promotion at the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues estimated the frequency and rates of emergency hospitalization after emergency department visits for adverse drug events in adults aged 65 years or older. Adverse event data were collected for 5,077 cases identified from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project from 2007 to 2009, and were used to assess the contribution of specific medications to hospitalizations.

The investigators identified approximately 99,628 emergency hospitalizations for adverse drug events in older adults each year. Adults aged 80 years or older accounted for 48.1 percent of these hospitalizations, and almost two-thirds of the hospitalizations (65.7 percent) resulted from unintentional overdoses. Sixty-seven percent of the hospitalizations involved four medications or medication classes, alone or in combination: warfarin (33.3 percent), insulin (13.9 percent), oral antiplatelet agents (13.3 percent), and oral hypoglycemic agents (10.7 percent). In 1.2 percent of hospitalizations, high-risk medications were implicated.

"Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate," the authors write.

Common antibiotics and blood pressure medication may result in hospitalization

Mixing commonly used antibiotics with common blood pressure medications may cause hypotension (abnormally low blood pressure) and induce shock in older patients, requiring hospitalization, according to a study published in CMAJ.

18 jan 2011--"Macrolide antibiotics (erythromycin, clarithromycin and azithromycin) are among the most widely prescribed antibiotics, with millions of prescriptions dispensed in Canada each year." writes Dr. David Juurlink, Scientist at the Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences with coauthors. "The drugs are generally well-tolerated, but they can cause several important drug interactions."

This study was conducted among Ontarians 66 years and older who were treated with a calcium-channel blocker (drugs often used to treat high blood pressure) between 1994 and 2009. The researchers then identified those who were hospitalized for low blood pressure and, in that group, whether or not a macrolide antibiotic had been prescribed shortly beforehand.

The researchers identified 7100 patients hospitalized for low blood pressure or shock while taking a calcium channel blocker. Treatment with erythromycin was found to increase the risk of low blood pressure almost 6-fold, while clarithromycin increased the risk almost 4-fold. In contrast, azithromycin did not increase the risk of hypotension.

"In older patients receiving calcium channel blockers, the two macrolide antibiotics erythromycin and clarithromycin are associated with a major increase in the risk of hospitalization for hypotension," conclude the authors. "However, the related drug azithromycin appears safe. When clinically appropriate, it should be used preferentially in patients receiving a calcium channel blocker."

Provided by Canadian Medical Association Journal

Analysis: Deaths from drug reactions up

By LINDSEY TANNER, AP Medical WriterTue Sep 11, 4:01 PM ET
Reports of dangerous side effects and deaths from widely used medicines almost tripled between 1998 and 2005, an analysis of U.S. drug data found.
The number of deaths and serious injuries from prescription and over-the-counter drugs climbed from 34,966 to 89,842 during the study of reports to the Food and Drug Administration.
Potent narcotic painkillers including Oxycontin, sold generically as oxycodone, were among 15 drugs most often linked with deaths in the study. Drugs frequently linked with serious nonfatal complications included insulin, the arthritis drugs Vioxx and Remicade, and the antidepressant Paxil.
The report adds to recent criticism of FDA oversight on drug safety, including its handling of serious problems connected with Vioxx, which was removed from the market in 2004.
"This growing toll of serious injury shows that the existing system is not adequately protecting patients and underscores the importance of recent reports urging far-reaching legislative, policy and institutional changes," the authors said.
The analysis appears in this week's issue of Archives of Internal Medicine. Its authors are Thomas Moore and Michael Cohen of the Institute for Safe Medication Practices, a nonprofit educational group that analyzes drug safety issues; and Dr. Curt Furberg of Wake Forest University School of Medicine.
They analyzed excerpts of reports on serious side effects received by the FDA between January 1998 and December 2005. A total of 467,809 serious complications were found. Reported deaths nearly tripled, rising from 5,519 to 15,107.
A disproportionate number of complications occurred in elderly patients. Women were more often victims than men, 55.5 percent compared to 45.5 percent. Children were involved in 7.4 percent of the problems.
The FDA issued a statement saying it is aware of the growing number of reported problems and takes them seriously, but the reason for the increase "is not completely known."
"While some of this has to do with the increasing number of prescriptions, there are clearly other factors responsible for this increase, such as the increase in public attention to drug safety, and use of the Internet to make it easier for the public to submit," Dr. Gerald Dal Pan of the FDA's surveillance and epidemiology office said in the statement.
Sen. Charles Grassley, an Iowa Republican and frequent FDA critic, said the report is another indication that the FDA's review of drugs already on the market "must be rigorous and timely."
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