|
PPI for peptic ulcer disease at full therapeutic dosage for >8 weeks
|
Earlier discontinuation or dose reduction for maintenance or prophylactic treatment of peptic ulcer disease, oesophagitis or GORD is indicated
|
16.69% [11]
|
|
7.68% [49]
|
|
4.06% [10]
|
|
NSAID (>3 months) for relief of mild joint pain in osteoarthritis
|
Simple analgesics are preferable and usually as effective for pain relief
|
8.76% [11]
|
|
1.05% [49]
|
|
1.26% [10]
|
|
Long-term (>1 month), long-acting benzodiazepines, for example, chlordiazepoxide, flurazepam, nitrazepam and clorazepate, and benzodiazepines with long-acting metabolites, for example, diazepam
|
Risk of prolonged sedation, confusion, impaired balance, falls
|
5.22% [11]
|
|
5.19% [49]
|
|
3.00% [49]
|
|
6.01% [10]
|
|
9.09% [10]
|
|
Any regular duplicate drug class prescription, for example, two concurrent opiates, NSAIDs, SSRIs, loop diuretics, ACE inhibitors. Excludes duplicate prescribing of drugs that may be required on a p.r.n. basis, for example, inhaled β2 agonists (long and short acting) for asthma or COPD, and opiates for management of breakthrough pain
|
Optimization of monotherapy within a single drug class should be observed prior to considering a new class of drug
|
4.78% [11]
|
|
2.18% [49]
|
|
6.01% [10]
|
|
TCAs with an opiate or calcium channel blocker
|
Risk of severe constipation
|
2.05% [11]
|
|
0.37% [49]
|
|
Aspirin at dosage >150 mg/day
|
Increased bleeding risk, no evidence for increased efficacy
|
1.69% [11]
|
|
0.3% [49]
|
|
0.14% [10]
|
|
Theophylline as monotherapy for COPD or asthma
|
Risk of adverse effects due to narrow therapeutic index
|
1.18% [11]
|
|
0.56% [10]
|
|
Use of aspirin and warfarin in combination without histamine H2 receptor antagonist (except cimetidine because of interaction with warfarin) or PPI
|
High risk of GI bleeding
|
1.09% [11]
|
|
0.3% [49]
|
|
Doses of short-acting benzodiazepines, doses greater than: lorazepam (Ativan®), 3 mg; oxazepam (Serax®), 60 mg; alprazolam (Xanax®), 2 mg; temazepam (Restoril®), 15 mg; and triazolam (Halcion®), 0.25 mg
|
Total daily doses should rarely exceed the suggested maximums
|
0.98% [49]
|
|
1.54% [10]
|
|
Prolonged use (>1 week) of first-generation antihistamines, that is, diphenhydramine, chlorpheniramine, cyclizine, promethazine
|
Risk of sedation and anticholinergic side-effects
|
0.96% [11]
|
|
0.15% [49]
|
|
Warfarin and NSAID together
|
Risk of GI bleeding
|
0.75% [11]
|
|
1.68% [10]
|
|
Calcium channel blockers with chronic constipation
|
May exacerbate constipation
|
0.68% [49]
|
|
0.28% [10]
|
|
NSAID with history of peptic ulcer disease or GI bleeding, unless with concurrent histamine H2 receptor antagonist, PPI or misoprostol
|
Risk of peptic ulcer relapse
|
0.67% [49]
|
|
0.42% [10]
|
|
Bladder antimuscarinic drugs with dementia
|
Risk of increased confusion, agitation
|
0.46% [11]
|
|
0.84% [10]
|
|
TCAs with constipation
|
May worsen constipation
|
0.45% [49]
|
|
0.14% [10]
|
|
Digoxin at a long-term dosage >125 μg/day (with impaired renal function)
|
Increased risk of toxicity
|
0.36% [11]
|
|
0.15% [49]
|
|
0.55% [10]
|
|
Thiazide diuretic with a history of gout
|
May exacerbate gout
|
0.36% [11]
|
|
0.45% [49]
|
|
0.14% [10]
|
|
Glibenclamide (with type 2 diabetes mellitus)
|
Risk of prolonged hypoglycaemia
|
0.29% [11]
|
|
0.22% [49]
|
|
Aspirin with a past history of peptic ulcer disease, without histamine H2 receptor antagonist or PPI
|
Risk of bleeding
|
0.22% [49]
|
|
0.28% [10]
|
|
Prochlorperazine (Stemetil®) or metoclopramide with parkinsonism
|
Risk of exacerbating parkinsonism
|
0.21% [11]
|
|
TCAs with dementia
|
Risk of worsening cognitive impairment
|
0.18% [11]
|
|
0.28% [10]
|
|
TCAs with glaucoma
|
Likely to exacerbate glaucoma
|
0.14% [11]
|
|
0.07% [49]
|
|
TCAs with cardiac conductive abnormalities
|
Pro-arrhythmic effects
|
0.14% [10]
|
|
Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthritis or osteoarthritis
|
Risk of major systemic corticosteroid side-effects
|
0.14% [10]
|
|
Bladder antimuscarinic drugs with chronic prostatism
|
Risk of urinary retention
|
0.14% [10]
|
|
NSAID with heart failure
|
Risk of exacerbation of heart failure
|
0.07% [49]
|
|
0.14% [10]
|
|
TCAs with prostatism or prior history of urinary retention
|
Risk of urinary retention
|
0.07% [49]
|
|
0.14% [10]
|
|
Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in COPD or asthma
|
Unnecessary exposure to long-term side-effects of systemic steroids
|
0.07% [49]
|
|
0.56% [10]
|
|
Bladder antimuscarinic drugs with chronic glaucoma
|
Risk of acute exacerbation of glaucoma
|
<0.01% [11]
|
|
NSAID with SSRI
|
Increased risk of GI bleeding
|
N/A
|
|
Bladder antimuscarinic drugs with chronic constipation
|
Risk of exacerbation of constipation
|
N/A
|
|
Prednisolone (or equivalent) > 3 months or longer without bisphosphonate
|
Increased risk of fracture
|
N/A
|
|
NSAID with ACE-inhibitor
|
Risk of kidney failure, particularly with the presence of general arteriosclerosis, dehydration or concurrent use of diuretics
|
N/A
|
|
NSAID with diuretic
|
May reduce the effect of diuretics and worsen existing heart failure
|
N/A
|
