We would like to thank Dr. Burkhardt for his important suggestions for polypsychopharmacological treatment. In particular, the information on the problem of combining several antidepressants or antipsychotics shows that pharmacotherapy in older adults requires a critical benefit-risk assessment. In our article (1), we therefore also refer to the Beers Criteria. The Beers list recommends that no more than three CNS-active drugs be used concurrently in older adults (2).
Nonetheless, psychopharmacological treatment for older adults is still important and necessary. Knowledge of specific pharmacodynamics and kinetics in older adults can help to avoid drug interactions and polypharmacy. Older patients are particularly at risk of polypharmacy. This can be due to not only multi-morbidity but also to an uncritical use of all guidelines for various underlying diseases (3). With an increasing number of drugs comes an increased risk of drug interactions and adverse drug reactions (ADRs). The pharmacokinetics and pharmacodynamics that change with age contribute to an additional increase in risk (4).
We would like to point out that there are numerous tools and instruments available for clinical practice that allow practical and sensible drug monitoring and that can identify the risks for possible interactions and ADRs at an early stage, to allow these to be avoided. In addition to drug monitoring (which should include blood level monitoring as well as dose adjustment for renal insufficiency and QTc prolongation), interaction platforms that used full-time in daily clinical practice can help to avoid interactions and polypharmacy. Knowledge of pharmacological specifics for old age can be obtained quickly and is less complicated than expected to apply in routine clinical practice, and this can not only improve the quality of life of the affected elderly patients but also help to avoid polypharmacy and its risks.
On behalf of the authors
Prof. Dr. med. Torsten Kratz
Abteilung für Psychiatrie,
Psychotherapie und Psychosomatik
Funktionsbereich Gerontopsychiatrie und -psychotherapie
Königin-Elisabeth-Herzberge Krankenhaus, Berlin
Conflict of interest statement
Prof. Kratz has received honoraria for preparing scientific continuing education events from Janssen-Cilag, Lilly, and Novo Nordisk.
|1.||Kratz T, Diefenbacher A: Psychopharmacological treatment in older people—avoiding drug interactions and polypharmacy. Dtsch Arztebl Int 2019; 116: 508–18 VOLLTEXT|
|2.||The 2019 American Geriatrics Society Beers Criteria Update Expert Panel: American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67: 674–94 CrossRef MEDLINE|
|3.||Dumbreck S, Flynn A, Nairn M, et al.: Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ 2015; 350: h949 CrossRef MEDLINE PubMed Central|
|4.||Moßhammer D, Haumann H, Mörike K, Joos S: Polypharmacy—an upward trend with unpredictable effects. Dtsch Arztebl Int 2016; 113: 627–33 CrossRef MEDLINE PubMed Central|