Disease relevance of Polypharmacy

• Generalized seizures, duration of epilepsy, and polypharmacy were significant determinants of BMD, more so at skeletal sites enriched in cortical bone [1].
• This study confirms the prevalence of polypharmacy in migraine, identifies the drugs used, and concludes that, on a population basis, the tolerability of s.c. sumatriptan, when used according to labeled instructions, is unaffected by these concomitant drugs [2].
• CONCLUSIONS: FBM urolithiasis can occur, and possible contributory factors include high felbamate dosage, drug polypharmacy, and risk factors for forming stones of other types [3].
• Crohn's disease patients on less than two medications at the intake visit had an HBI of 3.6 compared with 5.4 and 6.0 in the minor and major polypharmacy groups (P < 0.05) [4].
• BACKGROUND: Digoxin is often used in long-term care (LTC) residents with heart failure despite a high risk of toxicity associated with increased age, comorbidities and polypharmacy [5].

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

• Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease [11].
• The high proportion of suicides (44.1% of the total cases and 54.0% of the drug-caused deaths) and multiple-drug toxicities (88.6%) suggests that the involvement of propoxyphene in many of these fatalities may be of less significance than the phenomenon of "polypharmacy" and self-medication without appropriate medical supervision [12].

Biological context of Polypharmacy

• This observational study explored the effects of demographics, sickness, and polypharmacy on the non-steady state population pharmacokinetics of intravenous phenytoin [13].
• Moreover, since the elderly are generally subject to more polypharmacy than younger adults, are they, as a result, subject to either more frequent or more severe drug interactions with phenytoin than younger adults [14]?

Anatomical context of Polypharmacy

• We have studied thyroid function in 54 epileptic patients on a variety of drugs (19 on carbamazepine, 13 on phenytoin, 10 on sodium valproate, 12 on polypharmacy) [15].

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

• Careful monitoring of individual drug therapy from the onset of treatment improves compliance and seizure control and avoids unnecessary and harmful polypharmacy, and some of the neurological and psychosocial problems of chronic epilepsy [26].
• Use of animal models in developing guiding principles for polypharmacy in epilepsy [27].

References