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Combining the use of strong inhibitors or inducers of CYP3A4 and P-glycoprotein with direct oral anticoagulants is not recommended in older patients.
Choosing Wisely®
American Society of Consultant Pharmacists
Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban have significantly fewer drug-drug interactions (DDIs) compared with warfarin. However, there are notable DDIs with potent CYP3A4 and P-glycoprotein (p-gp) inhibitors with DOAC, which clinicians should consider requiring dose adjustments and monitoring for their older patients. Each of the DOACs is a substrate for p-glycoprotein (p-gp), an efflux transporter located in the intestinal mucosa, and therefore all DOACs ...
ver más ... 2022Do not prescribe currently available medicinal cannabis products to treat chronic non-cancer pain unless part of a registered clinical trial.
Choosing Wisely Australia
Faculty of Pain Medicine, ANZCA
Cannabis-derived products are now available for use with therapeutic intentions in Australia and New Zealand. By far the most common reason for their proposed use is chronic pain. More than 90% of Special Access Scheme – Category B approvals for cannabis products have been for chronic pain of various types. Cannabidiol-only formulations have not been the subject of a published randomised controlled trial for pain indications, yet they are projected to become the most widely used type of ...
ver más ... 2022It is not recommended to transfuse more units of blood than necessary.
Choosing Wisely Australia
Australian and New Zealand Society of Blood Transfusion
Every unit of blood transfused presents benefits and risks to the patients. Risks associated with transfusion include: -febrile reactions -allergic reactions and anaphylaxis -haemolytic reactions -transfusion- transmitted infections -transfusion-associated acute lung injury, transfusion-associated circulatory overload -alloimmunisation. Each unit transfused must have a clear indication and unnecessary transfusions must be avoided. A restrictive transfusion strategy (Haemoglobin (Hb) of ...
ver más ... 2022It is not recommended to prescribe tramadol without due consideration of potential risks and harms related to serotonergic excess, seizures, falls, and drug interactions in older adults.
Choosing Wisely®
American Society of Consultant Pharmacists
The utilization of tramadol, a weak and mixed centrally acting opioid analgesic, has increased steadily over the past decade, a trend influenced by perceived safety advantages over opioid medications like morphine, oxycodone, and hydrocodone. However, a recent national study reported that older adults account for 33% of tramadol-associated emergency department visits and half of subsequent hospitalizations, suggesting that greater scrutiny of tramadol’s safety in this population is ...
ver más ... 2022It is not recommended to use three or more CNS-active medications (antidepressants, benzodiazepines, Z-drugs, opioids, gabapentinoids, antipsychotics, antiepileptics), especially in older adults.
Choosing Wisely®
American Society of Consultant Pharmacists
There is strong evidence linking the use of multiple CNS-active medications with serious adverse drug events in older adults. Specifically, older adults taking multiple CNS-active medications are at an increased risk for falls and fractures. Furthermore, the combined use of opioids with gabapentinoids increases the risk of opioid-related death. There is high quality of evidence for avoiding combined use of benzodiazepine receptor agonists (benzodiazepines or Z-drugs defined as zopiclone, ...
ver más ... 2022