Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria

Abstract

Aim

The use of potentially inappropriate medications (PIM) can impair the safety and effectiveness of pharmacotherapy in the older adults. Thus, several countries have lists and criteria to indicate these drugs, in order to promote the safety of prescription and the rational use of drugs in geriatric practice.

Objective

This study sought to contribute to the inclusion of PIM for the older adults in the Brazilian criterion (BCPIM/2016) – current list used in Brazil and reference in Latin American countries – through expert approval, comparing convergences with international AGS lists BEERS/2019, STOPP/START/2015, PRISCUS/2010 and EU (7)-PIM List/2015.

Methods

This is a critical analysis of potentially inappropriate medications for use in the older adults present in the list of Brazilian criteria, together with their absence of some drugs that are on international lists (BEERS/2019; Priscus/2010; Stopp/Start/2015; EU7-PIM list/2015). This study was subdivided in 6 stages: selection of national criteria, classification of drugs according to Anatomic Therapeutic Chemical, comparison between BCPIM/2016 with international lists, selection of drugs not included in the Brazilian list, selection of experts for evaluation and suggestions about drugs not included in the Brazilian list and the synthesis of the analysis carried out by the specialists.

Results

We cataloged 66 drugs marketed in Brazil that are on international lists, but not in the Brazilian consensus, of which 24 were validated by experts as necessary for inclusion in this consensus, considering the risks and benefits in health care for the older adults. However, the lists have divergences and similarities between them. We observed that eight drugs were common to all criteria studied, mainly related to the nervous system.

Conclusion

The results suggest the need for periodic validation of PIM against research clinics, new drugs and the inclusion of this agenda by the Ministry of Health in the revision of the National List of Essential Drugs and other Clinical Protocols and Therapeutic Prescription Guidelines for the older adults.

Keywords:

• list of potentially inappropriate drugs
• seniors
• aging
• side effects
• drug-related adverse reactions

Acknowledgments

This work received support from the research’s members of University of Aging/University of Brasilia (UniSER/UnB), from Education and Human Aging Institute (IEEH) and from the research group – Human aging determinants from National Council for Scientific and Technological Development – CNPQ. We also thank Mr. Mateus de Castro for his contribution in the development of the third stage of this work.

Disclosure

The authors have no conflicts of interest to disclose.