Optimierung der Psychopharmakotherapie im Alter

Gudrun Hefner

doi:10.1055/a-1110-6277

Der Klinikarzt, Table of Contents

Der Klinikarzt 2020; 49(04): 146-155
DOI: 10.1055/a-1110-6277

Schwerpunkt

Optimierung der Psychopharmakotherapie im Alter

Geriatrisches Assessment und multidisziplinäre Maßnahmen

Gudrun Hefner

¹Vitos Klinik, Hochtaunus, Friedrichsdorf

› Author Affiliations

Abstract

ZUSAMMENFASSUNG

Das Medikamenten-Management wird bei Alterspatienten erschwert u. a. durch Gebrechlichkeit und Multimorbidität, Polypharmazie und Arzneimittelinteraktionen, Non-Adhärenz und die Veränderung pharmakodynamischer und pharmakokinetischer Parameter. Trotz erhöhter Arzneistoff-Blutspiegel im Vergleich mit jüngeren Patienten und einer gesteigerten Rezeptorsensitivität sollten jedoch nicht alle Alterspatienten per se nach dem Dictum „start low, go slow“ therapiert werden, um das Risiko einer Unterdosierung zu vermeiden. Jeder Alterspatient besitzt einen individuellen komplexen pharmakokinetischen und pharmakodynamischen Phänotyp, beeinflusst von multiplen Variablen. Therapeutisches Drug Monitoring (TDM) kann bei einer Psychopharmakotherapie helfen, den individuellen pharmakokinetischen Status und auch Non-Adhärenz zu erkennen, um die maximale effektive und verträgliche Dosis zu finden. Die Erfassung des pharmakodynamischen Status muss individuell klinisch erfolgen. Verschiedene Interventionen wurden erfolgreich entwickelt, um die Medikation bei Alterspatienten zu optimieren.

Full Text

References

Literatur
1 Demografiebericht Bundesministerium des Innern. Oktober 2011
2 Jacobi F, Hofler M, Siegert J. et al Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res 2014; 23: 304-319
3 Fried LP, Tangen CM, Walston J. et al Frailty in older adults: evidence for a phenotype. The journals of gerontology Series A, Biological sciences and medical sciences 2001; 56: M146-M156
4 Shamliyan T, Talley KM, Ramakrishnan R. et al Association of frailty with survival: A systematic literature review. Ageing Res Rev 2013; 12: 719-736
5 Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome. Am J Med 2007; 120: 748-753
6 McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004; 56: 163-184
7 Lotrich FE, Pollock BG. Aging and clinical pharmacology: implications for antidepressants. J Clin Pharmacol 2005; 45: 1106-1122
8 Ryan AA. Medication compliance and older people: a review of the literature. Int J Nurs Stud 1999; 36: 153-162
9 Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995; 56 (Suppl. 01) 18-22 discussion 23
10 Pasina L, Brucato AL, Falcone C. et al Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging 2014; 31: 283-289
11 Robinson RG, Schultz SK, Castillo C. et al Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: a placebo-controlled, double-blind study. Am J Psychiatry 2000; 157: 351-359
12 Banerjee S, Hellier J, Dewey M. et al Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011; 378: 403-411
13 Farina N, Morrell L, Banerjee S. What is the therapeutic value of antidepressants in dementia? A narrative review. Int J Geriatr Psychiatry 2017; 32: 32-49
14 Dudas R, Malouf R, McCleery J. et al Antidepressants for treating depression in dementia. Cochrane Database Syst Rev 2018; 8: CD003944
15 Koponen M, Taipale H, Lavikainen P. et al Risk of Mortality Associated with Antipsychotic Monotherapy and Polypharmacy Among Community-Dwelling Persons with Alzheimer’s Disease. J Alzheimers Dis 2017; 56: 107-118
16 Liperoti R, Sganga F, Landi F. et al Antipsychotic Drug Interactions and Mortality Among Nursing Home Residents With Cognitive Impairment. J Clin Psychiatry 2017; 78: e76-e82
17 Bohlken J, Booker A, Kostev K. [High Prevalence of Antipsychotic Medication Use in Dementia Patients in German Neuropsychiatric Practices]. Fortschr Neurol Psychiatr 2017; 85: 345-351
18 Pary R, Sarai SK, Micchelli A. et al Anxiety Disorders in Older Patients. Prim Care Companion CNS Disord 2019: 21
19 Jagsch C, Hofer A. [Diseases of the schizophrenia spectrum disorder in old age : Diagnostic and therapeutic challenges]. Z Gerontol Geriatr 2018; 51: 744-749
20 Kok RM. Reynolds CF, 3 rd. Management of Depression in Older Adults: A Review. JAMA 2017; 317: 2114-2122
21 Vasudev A, Chaudhari S, Sethi R. et al A Review of the Pharmacological and Clinical Profile of Newer Atypical Antipsychotics as Treatments for Bipolar Disorder: Considerations for Use in Older Patients. Drugs Aging 2018; 35: 887-895
22 Goldberg RM, Mabee J, Chan L. et al Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 1996; 14: 447-450
23 Hiemke C, Bergemann N, Clement HW. et al Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017. Pharmacopsychiatry 2018; 51: 9-62
24 Hefner G, Unterecker S, Ben-Omar N. et al Prevalence and type of potential pharmacokinetic drug-drug interactions in old aged psychiatric patients. CBHC 2015 Jul
25 Hefner G, Geschke K, Hiemke C. Severe adverse drug events under combination of nortriptyline and melperone due to pharmacokinetic interaction. J Clin Psychopharmacol 2014; 34: 394-396
26 Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997; 315: 1096-1099
27 Marras C, Herrmann N, Fischer HD. et al Lithium Use in Older Adults is Associated with Increased Prescribing of Parkinson Medications. Am J Geriatr Psychiatry 2016; 24: 301-309
28 Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug metabolism reviews 2009; 41: 67-76
29 Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004; 57: 6-14
30 Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38: 843-853
31 Fellgiebel A, Hautzinger M. Altersdepression. Kapitel: Pharmakotherapie bei Alterspatienten, Hiemke C, Hefner G 121-139 2017 Springer Verlag 2017
32 Sigurdsson HP, Hefner G, Ben-Omar N. et al Steady-state serum concentrations of venlafaxine in patients with late-life depression. Impact of age, sex and BMI. J Neural Transm (Vienna) 2015; 122: 721-729
33 Waade RB, Molden E, Refsum H. et al Serum concentrations of antidepressants in the elderly. Therapeutic drug monitoring 2012; 34: 25-30
34 Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. The Lancet 2007; 370: 185-191
35 Nagler EV, Webster AC, Vanholder R. et al Antidepressants for depression in stage 3–5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant 2012; 27: 3736-3745
36 Hiemke C, Shams M. Phenotyping and Genotyping of Drug Metabolism to Guide Pharmacotherapy in Psychiatry. Curr Drug Deliv 2013; 10: 46-53
37 Hefner G, Laib AK, Sigurdsson H. et al The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy. Int Rev Psychiatry 2013; 25: 494-508
38 Hefner G, Brueckner A, Hiemke C. et al Therapeutic drug monitoring for patients with Alzheimer dementia to improve treatment with donepezil. Ther Drug Monit 2015; 37: 353-361
39 Kuijpers MA, van Marum RJ, Egberts AC. et al Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008; 65: 130-133
40 Boehlen FH, Freigofas J, Herzog W. et al Evidence for underuse and overuse of antidepressants in older adults: Results of a large population-based study. Int J Geriatr Psychiatry 2019; 34: 539-547
41 Vestal RE. Aging and pharmacology. Cancer 1997; 80: 1302-1310
42 Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2003; 57: 6-14
43 Aymanns C, Keller F, Maus S. et al Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol 2010; 5: 314-327
44 Uchida H, Suzuki T, Graff-Guerrero A. et al Therapeutic window for striatal dopamine D(⅔) receptor occupancy in older patients with schizophrenia: a pilot PET study. Am J Geriatr Psychiatry 2014; 22: 1007-1016
45 Gründer G, Hiemke C, Paulzen M. et al Therapeutic plasma concentrations of antidepressants and antipsychotics: lessons from PET imaging. Pharmacopsychiatry 2011; 44: 236-248
46 Uchida H, Mamo DC, Mulsant BH. et al Increased antipsychotic sensitivity in elderly patients: evidence and mechanisms. J Clin Psych 2009; 70: 397-405
47 Uchida H, Kapur S, Mulsant BH. et al Sensitivity of older patients to antipsychotic motor side effects: a PET study examining potential mechanisms. Am J Geriatr Psychiatry 2009; 17: 255-263
48 Woolcott JC, Richardson KJ, Wiens MO. et al Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of internal medicine 2009; 169: 1952-1960
49 Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet 2007; 370: 185-191
50 McMahon FJ, Insel TR. Pharmacogenomics and personalized medicine in neuropsychiatry. Neuron 2012; 74: 773-776
51 Rogers SL, Friedhoff LT. The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US Multicentre, Randomized, Double-Blind, Placebo-Controlled Trial. The Donepezil Study Group. Dementia (Basel, Switzerland) 1996; 7: 293-303
52 Woosley RL HC, Gallo T, Tate J, Woosley D, Romero KA. www.CredibleMeds.org QTdrugs List. [06/2019], AZCERT, Inc 1822 Innovation Park Dr, Oro Valley, AZ 85755
53 Hiemke C, Eckermann G. Kombinationstherapie/Polypharmazie. Arzneimitteltherapie 2014; 32: 361-370
54 Gray SL, Hart LA, Perera S. et al Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults. J Am Geriatr Soc 2018; 66: 282-288
55 Curtin D, Gallagher PF, O’Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019; 10: 2042098619829431
56 Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Deutsches Arzteblatt international 2010; 107: 543-551
57 Hefner G, Stieffenhofer V, Gabriel S. et al Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy. Eur J Clin Pharmacol 2015; 71: 165-172
58 Pazan F, Weiss C, Wehling M. et al The FORTA (Fit fOR The Aged) List 2018: Third Version of a Validated Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2019; 36: 481-484
59 Wehling M. How to Use the FORTA (“Fit fOR The Aged”) List to Improve Pharmacotherapy in the Elderly. Drug Res (Stuttg) 2016; 66: 57-62
60 Wehling M, Throm C. [Polypharmacy in the elderly – choosing wisely by using the FORTA list]. Dtsch Med Wochenschr 2015; 140: 1378-1382
61 Michalek C, Wehling M, Schlitzer J. et al Effects of “Fit fOR The Aged” (FORTA) on pharmacotherapy and clinical endpoints--a pilot randomized controlled study. Eur J Clin Pharmacol 2014; 70: 1261-1267
62 Pazan F, Burkhardt H, Frohnhofen H. et al Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments. Eur J Clin Pharmacol 2018; 74: 339-347
63 Airagnes G, Pelissolo A, Lavallee M. et al Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management. Curr Psychiatry Rep 2016; 18: 89
64 Hessmann P, Dodel R, Baum E. et al Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease. Pharmacopsychiatry 2019; 52: 84-91
65 Liew TM, Lee CS, Goh Shawn KL. et al Potentially Inappropriate Prescribing Among Older Persons: A Meta-Analysis of Observational Studies. Ann Fam Med 2019; 17: 257-266
66 Williams S, Miller G, Khoury R. et al Rational deprescribing in the elderly. Ann Clin Psychiatry 2019; 31: 144-152
67 Wickop B, Harterich S, Sommer C. et al Potentially Inappropriate Medication Use in Multimorbid Elderly Inpatients: Differences Between the FORTA, PRISCUS and STOPP Ratings. Drugs Real World Outcomes 2016; 3: 317-325
68 Hefner G, Shams ME, Wenzel-Seifert K. et al Rating the delirogenic potential of drugs for prediction of side effects in elderly psychiatric inpatients. J Pharma Pharmacovigilance 2015; 1 (01) 003
69 Kramer D, Veeranki S, Hayn D. et al Development and Validation of a Multivariable Prediction Model for the Occurrence of Delirium in Hospitalized Gerontopsychiatry and Internal Medicine Patients. Stud Health Technol Inform 2017; 236: 32-39
70 Lee MS, Kisely S, Zolotarev B. et al Anticholinergic burden in older inpatients on psychotropic medication: do we care?. Australas Psychiatry 2017; 25: 566-570
71 Tsoutsoulas C, Mulsant BH, Kumar S. et al Anticholinergic Burden and Cognition in Older Patients With Schizophrenia. J Clin Psychiatry 2017; 78: e1284-e1290
72 Walker J, Wynne H. Review: the frequency and severity of adverse drug reactions in elderly people. Age and ageing 1994; 23: 255-259
73 Atkin PA, Veitch PC, Veitch EM. et al The epidemiology of serious adverse drug reactions among the elderly. Drugs & aging 1999; 14: 141-152
74 Letmaier M, Grohmann R, Kren C. et al Venous thromboembolism during treatment with antipsychotics: Results of a drug surveillance programme. World J Biol Psychiatry 2018; 19: 175-186
75 Onder G, Petrovic M, Tangiisuran B. et al Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med 2010; 170: 1142-1148
76 Hefner G, Hahn M, Roll SC. et al Application of the GerontoNet ADR Risk Score in a Psychiatric Setting. Int J Clin Med Res 2018; 5: 7-14
77 Samsa GP, Hanlon JT, Schmader KE. et al A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol 1994; 47: 891-896