The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Jun 2008
Case ReportsAdverse effects of propafenone after long-term therapy with the addition of citalopram.
Propafenone, a class IC antiarrhythmic, and citalopram, a selective serotonin reuptake inhibitor (SSRI), are widely used in older patients. Although a potential interaction between propafenone and SSRIs has been noted, a MEDLINE search revealed no published reports of an interaction between propafenone and citalopram. ⋯ This is the first report of a possible interaction between propafenone and citalopram, which caused propafenone adverse effects (eg, dizziness, falls) and mimicked coronary artery disease.
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Am J Geriatr Pharmacother · Dec 2007
ReviewPharmacologic prevention of aspiration pneumonia: a systematic review.
Aspiration pneumonia is a common cause of morbidity and mortality. Several approaches, including bed positioning, dietary changes, and oral hygiene, have been proposed to prevent aspiration pneumonia, yet few data are available on the efficacy of pharmacologic interventions in reducing the rate of aspiration. ⋯ Limited information is available on benefits and risks to guide an evidence-based approach to the pharmacologic prevention of aspiration pneumonia. Considering the high incidence of aspiration pneumonia in older adults, large randomized clinical trials on the effectiveness of pharmacologic interventions are warranted.
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Polypharmacy is a significant problem among older adults. Patient-related characteristics and beliefs have not been the focus of prior research in this area, which has primarily evaluated the effects of patients' health status and health care system factors. ⋯ We found a very high prevalence of unnecessary drug use in this older veteran outpatient population. Race, income, and polypharmacy, as well as health-related beliefs, were central factors associated with unnecessary drug use.
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Am J Geriatr Pharmacother · Sep 2007
Clinical TrialReport on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication.
Studies of pharmacotherapy for agitation in dementia have primarily been limited to single-drug trials and have not determined if some forms of agitated behaviors are more responsive to treatment than others. ⋯ Patients with higher levels of agitation receiving divalproex had reduced agitation on the physical aggression subscale of the CMAI. Divalproex was less effective on physically nonaggressive behavior and verbal agitation. Irritability, as measured on the NPI-NH, was also reduced. Patients who received both divalproex and an antipsychotic agent were responsive at lower doses of divalproex. In either case, the effective dosage of divalproex was lower than that commonly used for epilepsy or mania in elderly patients. The most common adverse events included somnolence and gait disturbance.