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response of 4/5 (agree/strongly agree) and a 25th centile of

4 were

included in the final criteria.


Three Delphi rounds were required. All panellists completed

all rounds. Thirty criteria were proposed for inclusion; 27 were

accepted. No new criteria were added. The first two criteria suggest

deprescribing medications with no indication or where compliance

is poor. The remaining 25 criteria include lipid-lowering therapies,

alpha-blockers for hypertension, anti-platelets, memantine, neuro-

leptics, proton pump inhibitors, H-2 receptor antagonists, anti-

spasmodics, theophylline, leukotriene antagonists, calcium supple-

ments, bone anti-resorptive therapy, selective oestrogen receptor

modulators, non-steroidal anti-inflammatories, corticosteroids, 5-

alpha reductase inhibitors, alpha-1 selective blockers, muscarinic

antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor

blockers, systemic oestrogens, multivitamins, nutritional supplements

and prophylactic antibiotics. Anticoagulants and anti-depressants

were excluded. Despite incorporation of panellists


acetyl-cholinesterase inhibitors remained inconclusive.


STOPPFrail comprises 27 criteria that are potentially

inappropriate in frailer older patients with limited life expectancy.

STOPPFrail may assist in deprescribing medications in these patients.


Unavailability of drugs as a cause of inappropriately omitted

antiparkinsonian doses in Parkinson

s disease inpatients

U. Lertxundi, A. Isla, M.A. Solinís, R. Hernández, S. Domingo-Echaburu,

J. Peral-Aguirregoitia.


One of the most important risk factor for motor

function deterioration in Parkinson

s Disease when patients are

admitted to hospital is wrong timing of antiparkinsonian drug

administration, which has, more recently, shown to prolong hospital

stays in about 4 days.


All PD patients admitted to any of the 11 public acute care

hospitals in the Basque Country during 2011

2012 were included.

Since 2011, all hospitals share a single informatics application (e-

Osabide) for inpatient pharmacotherapeutic management including

electronic administration records. When a registry of no administra-

tion was made for a certain dose, the reason for omission was also

recorded. We chose omitted doses only due to unavailability of the

prescribed drug.


We included 1.628 patients admitted 2.546 times. Of the

80.043 prescribed antiparkinsonian doses, 210 were not administered

because the prescribed drug was not available on time. In all 11 acute

health care hospitals at least one dose could not be administered

because of this reason. The most frequently implicated drug was L-

Dopa in combination (104 doses) followed by pramipexole (31 doses),

ropinirole (30 doses), rotigotine (19 doses), rasagiline (19 doses),

entacapone (3 doses), cabergoline (2 doses) and selegiline (2 doses).


Antiparkinsonian drug omissions occurred in all

hospitals. The most frequent omitted drug was L-Dopa in combination.

In our opinion having all possible drugs on time, as suggested by some

authors, seems unfeasible especially in small hospitals. A therapeutic

interchange protocol where each unavailable drug is converted to the

equivalent levodopa dose could be a realistic solution.


Danish register-based cohort study on the dosage association

between antidepressants and hyponatremia

K. Leth-Møller


, M. Torstensson


, S.E. Andersen


, G. Gislasson


, C. Torp-



, E.A. Holm




Department of Geriatric Medicine, Nykøbing

Falster Hospital, Nykøbing Falster,


Clinical Pharmacology Unit,

University Hospital Zealand, Roskilde,


Department of Cardiology,

Gentofte Hospital, Hellerup,


Institute of Health, Science and Technology,

Aalborg University, Aalborg, Denmark


There is a known association between some antidepres-

sants and hyponatremia. In case of drug-induced hyponatremia it is

common practice to reduce the dosage, however the effect of lowering

the dosage is not fully investigated. The aim of this study is to

investigate the association between high and low dosage of the most

commonly used antidepressants and hyponatremia.


This is an observational Danish register-based cohort

study using nationwide registers. The study cohort consisted of all

residents in The North Denmark Region who initiated treatment with

antidepressants from January 1st 1998 to December 31th 2012. The

association between high and low dosage of different antidepressants

and hyponatremia was analysed using multivariable Poisson regres-

sion models to determine incidence rate ratios (IRR).


There were 91,100 individuals included in the study, of these

13.77% (n = 12,550) had an event of hyponatremia. Using low dose as

reference IRRs and confidence intervals (CI) for the association with

hyponatremia and high doses were for citalopram (40 mg) 1.11 (CI


1.21); escitalopram (20

40 mg) 1.22 (CI 1.01

1.47); paroxetine


60 mg) 1.57 (CI 1.22

2.01); sertraline (100

200 mg) 1.96 (CI 1.65

2.32); venlafaxine (150

300 mg) 1.21 (CI 0.99

1.49) and mirtazapine


45 mg) 1.14 (1.00


Key conclusions:

Our study showed an increased risk of hyponatremia

for high dosage compared to low dosage for all included antidepres-

sants, except venlafaxine.


Comparison of tools to reduce polypharmacy on hospital discharge

in a real-world elderly population

M. Debney


, R. Taylor


, K. Elliott


, C. Lisk




Barnet Hospital, Royal Free

Nhs Foundation Trust, UK


As the UK population ages, survival from chronic illness

increases the prescribing of medications and the burden of poly-

pharmacy. We sought to compare and determine the effectiveness of

validated tools on reducing the number of medications prescribed on

discharge from a cohort of elderly patients.


All patients over the age of 65, discharged from a UK

hospital between 16th January and 30th January 2015 were identified

from discharge records. Demographics, co-morbidities and total

number of medications on discharge were recorded. The modified

Beers Criteria and the Screening Tool of Older People

s potentially

inappropriate Prescriptions (STOPP) criteria were retrospectively



139 patients (average age of 82 ± 10 years), (45% male) with

multiple co-morbidities (median 3, range 0

8) were identified. Each

patient was prescribed an average of eight medications. Application of

the Beers Criteria in both strict (stopping drugs listed as


medication use

) and broad (stopping medications listed as


priate medication use


drug-disease interactions


use with


) and STOPP resulted in a significant reduction in average

number of medications on discharge (original 8 ± 4 medication vs.

Beers Strict Criteria 7 ± 4 (paired t-test, p < 0.05) vs. Beers Broad Criteria

7 ± 4, (paired t-test, p < 0.05) vs STOPP 7 ± 3 (paired t-test, p < 0.05)).


This study suggests that the implementation of poly-

pharmacy screening pre-discharge may afford a reduction in medica-

tions and should be considered as part of the discharge process for

elderly patients. Application of STOPP criteria afforded a medication

reduction much more compared to the Beers Criteria.


Our knowledge of herbal medicines as healthcare professionals

needs to be better

M. Kelshiker


, C. Lisk




Barnet Hospital, Royal Free Nhs Foundation Trust,

United Kingdom


Older adults are increasingly using herbal medicines

(HM) to boost longevity, treat pain and boost memory. It is therefore

important for health care professionals (HCPs) to have a working

knowledge about HM.


A cross sectional web-based survey of HCPs working within

the Department of Medicine at a UK district general hospital was

carried looking at their knowledge of HM.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29