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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)
MeSH Review


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Disease relevance of Polypharmacy


High impact information on Polypharmacy

  • An extensive review of recent medication in patients with disorders of glucose tolerance and the avoidance of polypharmacy are recommended [6].
  • Management of epilepsy in the elderly involves many challenges, including the presence of concomitant diseases, polypharmacy and changes in body physiology [7].
  • Polypharmacy and the use of over-the-counter (OTC) medications are important considerations in this cohort of patients [8].
  • Compared to admissions in 1984-1988, admissions in 1989-1993 were significantly shorter and involved longer periods of polypharmacy with multiple antipsychotic medications but included lower mean chlorpromazine-equivalent doses of medication [9].
  • With the exception of divalproex, there are currently no compelling data to justify the use of antipsychotic polypharmacy or augmentation [10].

Chemical compound and disease context of Polypharmacy


Biological context of Polypharmacy


Anatomical context of Polypharmacy


Associations of Polypharmacy with chemical compounds

  • Groups did not differ in the proportion of patients on polypharmacy or with subtherapeutic serum antiepileptic drug levels, but there was a trend for greater use of phenobarbital in patients (57% versus 38%, odds ratio (OR) = 2.6, p = 0.057) [16].
  • Thus, treatment with selegiline makes it possible to avoid polypharmacy and to use a potent stimulant without known addiction risk [17].
  • Lithium plus valproate as maintenance polypharmacy for patients with bipolar I disorder: a review [18].
  • Over half of patients received decanoate medications, polypharmacy was nontrivial, and there was variability in prescribing patterns across physicians [19].
  • Microemulsion electrokinetic chromatography applied for separation of levetiracetam from other antiepileptic drugs in polypharmacy [20].

Gene context of Polypharmacy

  • Due to polypharmacy and the need for chronic treatment, Pgp inhibitors used in epilepsy should be highly specific and non-toxic [21].
  • Polypharmacy may have specific relevance for elderly patients treated with cyclosporin since this agent is a substrate of both CYP3A and P-glycoprotein, both of which are important in the elimination of many commonly used drugs [22].
  • Second, it may be helpful to consider P450 enzymes when adverse events occur during polypharmacy [23].
  • Concurrent supportive psychosocial treatment or polypharmacy may be useful in treating the adult with comorbid ADHD [24].
  • Polypharmacy with other drugs utilizing the same enzyme, or inhibiting CYP3A4, can lead to TdP [25].

Analytical, diagnostic and therapeutic context of Polypharmacy


  1. Effect of antiepileptic drugs on bone density in ambulatory patients. Farhat, G., Yamout, B., Mikati, M.A., Demirjian, S., Sawaya, R., El-Hajj Fuleihan, G. Neurology (2002) [Pubmed]
  2. Migraine polypharmacy and the tolerability of sumatriptan: a large-scale, prospective study. Putnam, G.P., O'Quinn, S., Bolden-Watson, C.P., Davis, R.L., Gutterman, D.L., Fox, A.W. Cephalalgia : an international journal of headache. (1999) [Pubmed]
  3. Felbamate urolithiasis. Sparagana, S.P., Strand, W.R., Adams, R.C. Epilepsia (2001) [Pubmed]
  4. Polypharmacy and Crohn's disease. Cross, R.K., Wilson, K.T., Binion, D.G. Aliment. Pharmacol. Ther. (2005) [Pubmed]
  5. Digoxin prescribing for heart failure in elderly residents of long-term care facilities. Misiaszek, B., Heckman, G.A., Merali, F., Turpie, I.D., Patterson, C.J., Flett, N., McKelvie, R.S. The Canadian journal of cardiology. (2005) [Pubmed]
  6. Drug-induced disorders of glucose tolerance. Pandit, M.K., Burke, J., Gustafson, A.B., Minocha, A., Peiris, A.N. Ann. Intern. Med. (1993) [Pubmed]
  7. Treatment of epilepsy in the elderly. Gareri, P., Gravina, T., Ferreri, G., De Sarro, G. Prog. Neurobiol. (1999) [Pubmed]
  8. Management of pain in patients with multiple health problems: a guide for the practicing physician. Ruoff, G. Am. J. Med. (1998) [Pubmed]
  9. Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience. Phillips, M.R., Lu, S.H., Wang, R.W. The American journal of psychiatry. (1997) [Pubmed]
  10. A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Stahl, S.M., Grady, M.M. Current medicinal chemistry. (2004) [Pubmed]
  11. Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease. Nyholm, D., Nilsson Remahl, A.I., Dizdar, N., Constantinescu, R., Holmberg, B., Jansson, R., Aquilonius, S.M., Askmark, H. Neurology (2005) [Pubmed]
  12. Propoxyphene in postmortem toxicology 1976-1978. Finkle, B.S., Caplan, Y.H., Garriott, J.C., Monforte, J.R., Shaw, R.F., Sonsalla, P.K. J. Forensic Sci. (1981) [Pubmed]
  13. Non-steady state population kinetics of intravenous phenytoin. Frame, B., Beal, S.L. Therapeutic drug monitoring. (1998) [Pubmed]
  14. Differential kinetics of phenytoin in elderly patients. Bachmann, K.A., Belloto, R.J. Drugs & aging. (1999) [Pubmed]
  15. Thyroid hormone concentrations in epileptic patients. Larkin, J.G., Macphee, G.J., Beastall, G.H., Brodie, M.J. Eur. J. Clin. Pharmacol. (1989) [Pubmed]
  16. Risk factors for status epilepticus in children with symptomatic epilepsy. Novak, G., Maytal, J., Alshansky, A., Ascher, C. Neurology (1997) [Pubmed]
  17. Selegiline in the treatment of narcolepsy. Hublin, C., Partinen, M., Heinonen, E.H., Puukka, P., Salmi, T. Neurology (1994) [Pubmed]
  18. Lithium plus valproate as maintenance polypharmacy for patients with bipolar I disorder: a review. Solomon, D.A., Keitner, G.I., Ryan, C.E., Miller, I.W. Journal of clinical psychopharmacology. (1998) [Pubmed]
  19. Antipsychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. Covell, N.H., Jackson, C.T., Evans, A.C., Essock, S.M. Schizophrenia bulletin. (2002) [Pubmed]
  20. Microemulsion electrokinetic chromatography applied for separation of levetiracetam from other antiepileptic drugs in polypharmacy. Ivanova, M., Piunti, A., Marziali, E., Komarova, N., Raggi, M.A., Kenndler, E. Electrophoresis (2003) [Pubmed]
  21. OC144-093, a novel P glycoprotein inhibitor for the enhancement of anti-epileptic therapy. Newman, M.J., Dixon, R., Toyonaga, B. Novartis Found. Symp. (2002) [Pubmed]
  22. Cyclosporin pharmacokinetics in the elderly. Kovarik, J.M., Koelle, E.U. Drugs & aging. (1999) [Pubmed]
  23. Cytochrome P450 enzymes: interpretation of their interactions with selective serotonin reuptake inhibitors. Part II. Harvey, A.T., Preskorn, S.H. Journal of clinical psychopharmacology. (1996) [Pubmed]
  24. Adults with ADHD. An overview. Wender, P.H., Wolf, L.E., Wasserstein, J. Ann. N. Y. Acad. Sci. (2001) [Pubmed]
  25. Drugs that cause Torsades de pointes and increase the risk of sudden cardiac death. Wolbrette, D.L. Current cardiology reports. (2004) [Pubmed]
  26. The pharmacological management of epilepsy associated with psychological disorders. Reynolds, E.H. The British journal of psychiatry : the journal of mental science. (1982) [Pubmed]
  27. Use of animal models in developing guiding principles for polypharmacy in epilepsy. Löscher, W., Wauquier, A. Epilepsy Res. Suppl. (1996) [Pubmed]
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