Forty percent of hospitalized elderly patients are at risk for at least one drug-disease interaction, according to researchers who studied 397 frail elderly patients in a trial conducted at 11 Veterans Affairs medical centers.
The most common potential interactions involved calcium-channel block-ers and heart failure (12.3%) and beta blockers and diabetes (6.8%). In fact, beta blockers were implicated more than once, with peripheral vascular disease or Raynaud’s disease and chronic obstructive pulmonary disease. Aspirin was linked to peptic ulcer disease. Patients aged 75 and older and those with multiple illnesses were at higher risk.
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Health care professionals may be able to reduce the potential negative impact of the most common interactions, for example, by co-prescribing gastroprotective agents with aspirin and other NSAIDs. In older patients, the total body clearance of commonly used cardioselective beta blockers may be reduced and higher blood concentrations may result in loss of cardioselective properties. Thus, caution, more vigorous monitoring, and perhaps lower doses are advised.