Polypragmazie a jak jí předcházet

Authors: Jan Miroslav Hartinger;  Daniel Laurus Bobek
Authors place of work: Farmakologický ústav 1. LF UK a VFN v Praze
Published in the journal: Čas. Lék. čes. 2024; 162: 3-8
Category: Přehledové články


Polypharmacy is currently a serious problem that causes decrease in adherence and increased number of hospitalizations and mortality. WHO addresses polypharmacy in the Medication Without Harm campaign. Other initiatives that deal with polypharmacy are the International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP) and Choosing Wisely campaign.

The correct approach to address polypharmacy consists of its prevention, i.e. not prescribing inappropriate or unnecessary medication and providing clear timeframe for medication that should not be continued life-long. Further on we should actively seek patients suffering from polypharmacy and intervene it by deprescription. Correctly provided deprescription can be done by means of various tools beginning from simple lists of inappropriate drugs (Beers criteria, STOPP/START) to more comprehensive approaches that evaluate the importance of each particular drug in patient’s medication list and help to identify the least important ones that are candidates for deprescription (Medication Appropriateness Index, Good Palliative Geriatric Practice Algorithm and others).

When evaluating the appropriateness of pharmacotherapy, we always check if the treatment aim is achieved, if the indication persists, appropriateness of dosing and if the patient understands the pharmacotherapeutical regimen. By this approach we try to eliminate the pharmacotherapy with very low or no benefit for particular patient. Clinical pharmacologist or pharmacist can significantly help with this time-consuming process.


deprescription, Medication Appropriateness Index, Choosing Wisely, low value care

1.    Mair A, Wilson M, Dreischulte T. Addressing the challenge of polypharmacy. Annu Rev Pharmacol Toxicol 2020; 60: 661–681.
2.    Mangin D, Bahat G, Golomb BA et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position statement and 10 recommendations for action. Drugs Aging 2018; 35: 575–587.
3.    Chang TI, Park H, Kim DW et al. Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Scientific Reports 2020; 10: 18964.
4.    Donaldson LJ, Kelley ET, Dhingra-Kumar N et al. Medication Without Harm: WHO's Third Global Patient Safety Challenge. Lancet 2017; 389: 1680–1681.
5.    Rakušan D, Grenar P, Nový J et al. Choosing Wisely: „Když méně je více…“. Aktuální medicína 2023; 2: 12–14.
6.    Mafi JN, Parchman M. Low-value care: an intractable global problem with no quick fix. BMJ Qual Saf 2018; 27: 333.
7.    Pilková A. Inhibitory protonové pumpy v praxi klinického farmaceuta. Čas Lék Čes 2019; 158: 282–288.
8.    Gill SS, Mamdani M, Naglie G et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 2005; 165: 808–813.
9.    Chen Z, Liu Z, Zeng L et al. Research on prescribing cascades: a scoping review.  Front Pharmacol 2023; 14: 1147921.
10.  Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr 2020; 43: 114–120.
11.  SPC Donepezil Accord. Dostupné na: https://prehledy.sukl.cz/prehledy/v1/dokumenty/63963
12.  Ritvo AD, Foster DE, Huff C et al. Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLoS One 2023; 18: e0285584.
13.  Niklasson A, Lindström L, Simrén M et al. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am J Gastroenterol 2010; 105: 1531–1537.
14.  Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2009; Cd003120.
15.  Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev 2013; Cd003852.
16.  Flicker L, Grimley Evans G. Piracetam for dementia or cognitive impairment. Cochrane Database Syst Rev 2001; Cd001011.
17.  O’Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Expert Rev Clin Pharmacol 2020; 13: 15–22.
18.  Seppala LJ, Petrovic M, Ryg J et al. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age Ageing 2021; 50: 1189–1199.
19.  Fick DM, Semla TP, Steinma M et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67: 674–694.
20.  Egberts A, Moreno-Gonzalez R, Alan H et al. Anticholinergic Drug Burden and Delirium: A Systematic Review. J Am Med Dir Assoc 2021; 22: 65–73.e64.
21.  Hanlon JT, Schmader KE, Samsa GP et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992; 45: 1045–1051.
22.  Somers A, Mallet L, van der Cammen T et al. Applicability of an adapted medication appropriateness index for detection of drug-related problems in geriatric inpatients. Am J Geriatr Pharmacother 2012; 10: 101–109.
23.  Hanlon JT, Schmader KE. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging 2013; 30: 893–900.
24.  Bushardt RL, Jones KW. Nine key questions to address polypharmacy in the elderly. JAAPA 2005; 18: 32–37.
25.  Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010; 170: 1648–1654.
26.  Watson KE, Dhaliwal K, McMurtry E et al. Sick day medication guidance for people with diabetes, kidney disease, or cardiovascular disease: a systematic scoping review. Kidney Med 2022; 4: 100491.
27.  Page AT, Clifford RM, Potter K et al. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol 2016; 82: 583–623.
28.  Martin P, Tamblyn R, Benedetti A et al. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. Jama 2018; 320: 1889–1898.
29.  Bates D, Schultheis BC, Hanes MC et al. A Comprehensive algorithm for management of neuropathic pain. Pain Med 2019; 20: S2–S12.
30.  Silber MH, Buchfuhrer MJ, Earley CJ et al. The Management of restless legs syndrome: an updated algorithm. Mayo Clin Proc 2021; 96: 1921-1937.
Adiktológia Alergológia a imunológia Angiológia Audiológia a foniatria Biochémia Dermatológia Detská gastroenterológia Detská chirurgia Detská kardiológia Detská neurológia Detská otorinolaryngológia Detská psychiatria Detská reumatológia Diabetológia Farmácia Chirurgia cievna Algeziológia Dentální hygienistka

Článok vyšiel v časopise

Časopis lékařů českých

Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle

Zvýšte si kvalifikáciu online z pohodlia domova

Eozinofilní granulomatóza s polyangiitidou
nový kurz
Autori: doc. MUDr. Martina Doubková, Ph.D.

Všetky kurzy
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.


Nemáte účet?  Registrujte sa