Criterion | Concern | Prevalence in Ireland* |
---|---|---|
PPI for peptic ulcer disease at full therapeutic dosage for >8Â 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 (>3Â 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 (>1Â 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 >150Â 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 (>1Â 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 (>3Â 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 |