LNSLNS

The PRISCUS list lacks a vital piece of information. The issue under discussion is inappropriate medications for elderly patients, but age is specified neither in terms of years nor in terms of a clinically more adequate characterization. This means that the dilemma of imprecise definition persists. The definition of age has been the subject of academic discussion for years and urgently requires clarification and agreement.

Further, the PRISCUS list suggests risperidone as a therapeutic alternative to neuroleptic drugs in patients with dementia. However, risperidone has not been recommended for this group of patients since 2005, and the summary of product characteristics makes this explicit. A meta-analysis of the licensing authorities has shown a trend towards higher mortality in older dementia patients (risperidone 4.0%, placebo 3.1%) (1). Even though the use of risperidone may be a therapeutic option in view of the limited alternatives, it has to be borne in mind that the pharmaceutical company with its product information rules out its own liability.

Nonetheless, the development and publication of the PRISCUS list means an important step towards improved pharmacotherapy of elderly patients. A useful addition to the PRISCUS list is the list of suitable medications published by Stefanacci (2).

As a next step, a prospective evaluation should be planned to find out whether intake of the PRISCUS preparations is really associated with a higher rate of problems. The medium term goal is to implement the elements from the PRISCUS list that have received a positive evaluation into the national disease management guidelines and into doctors’ prescribing software.

DOI: 10.3238/arztebl.2010.0899b

Dipl.-Pharm. Thomas Fiß

Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)

Ellernholzstr. 1/2

17487 Greifswald, Germany

E-Mail: thomas.fiss@dzne.de

Prof. Dr. med. Wolfgang Hoffmann, MPH

Institut für Community Medicine

Ellernholzstr. 1/2

17487 Greifswald, Germany

E-Mail: wolfgang.hoffmann@uni-greifswald.de

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

1.
Haupt M, Cruz-Jentoft A, Jeste D: Mortality in elderly dementia
patients treated with risperidone. J Clin Psychopharmacol 2006; 26: 566–70. MEDLINE
2.
Stefanacci RG, Cavallaro E, Beers MH, Fick DM: Developing explicit positive beers criteria for preferred central nervous system medications in older adults. Consult Pharm 2009; 24: 601–10. MEDLINE
3.
Holt S, Schmiedl S, Thürmann PA: Potentially inappropriate medications in the elderly: The PRISCUS list. Dtsch Arztebl Int 2010; 107(31–32): 543–51. VOLLTEXT
1. Haupt M, Cruz-Jentoft A, Jeste D: Mortality in elderly dementia
patients treated with risperidone. J Clin Psychopharmacol 2006; 26: 566–70. MEDLINE
2. Stefanacci RG, Cavallaro E, Beers MH, Fick DM: Developing explicit positive beers criteria for preferred central nervous system medications in older adults. Consult Pharm 2009; 24: 601–10. MEDLINE
3.Holt S, Schmiedl S, Thürmann PA: Potentially inappropriate medications in the elderly: The PRISCUS list. Dtsch Arztebl Int 2010; 107(31–32): 543–51. VOLLTEXT