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Table 2 Selected prescribing criteria and indicators

From: Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol)

Criterion Concern Prevalence in Ireland*
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
  1. ACEI, angiotensin-converting-enzyme inhibitor; COPD, chronic obstructive pulmonary disease; GI, gastro-intestinal; GORD, gastro-oesophageal reflux disease; N/A, not available; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor; p.r.n., pro re nata, as needed; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic anti-depressant. *Prevalence: the proportion of the study population with one or more potentially inappropriate medications.