Table 2 Prevalence of potentially inappropriate prescribing by individual STOPP criteria among older people in CPRD

Cardiovascular system

Digoxin > 125 mcg/day (increased risk of toxicity) ^a

9327

0.9 (0.8-0.9)

Thiazide diuretics with gout (exacerbates gout)

6094

0.6 (0.6-0.6)

Beta-blocker + verapamil (risk of symptomatic heart block)

503

0.05 (0.05-0.05)

Aspirin + Warfarin without a PPI/ H₂RA (high risk of gastrointestinal bleeding)

3616

0.4 (0.3 -0.4)

Dipyridamole as monotherapy for cardiovascular secondary prevention (no evidence of efficacy)

2137

0.2 (0.2-0.2)

Aspirin > 150 mg/day ( increased bleeding risk)

5128

0.5 (0.5-0.5)

Loop diuretic for dependent ankle oedema only i.e. no clinical signs of heart failure (no evidence of efficacy, compression hosiery usually more appropriate)

25843

2.54 (2.5-2.6)

Loop diuretic as first-line monotherapy for hypertension (safer, more effective alternatives available)

7128

0.7 (0.7-0.7)

Non-cardioselective beta-blocker with Chronic Obstructive Pulmonary Disease (COPD) (risk of bronchospasm)

353

0.03 (0.03-0.03)

Calcium channel blockers with chronic constipation (may exacerbate constipation)

16826

1.6 (1.6-1.7)

Aspirin with a past history of peptic ulcer disease without histamine H2 receptor antagonist or Proton Pump Inhibitor (risk of bleeding)

3912

0.4 (0.4-0.4)

Aspirin with no history of coronary, cerebral or peripheral vascular symptoms or occlusive arterial event (not indicated)

115576

11.3 (11.3-11.4)

Central Nervous System

TCAs with dementia (worsening cognitive impairment)

354

0.03 (0.03-0.03)

TCAs with glaucoma (exacerbate glaucoma)

354

0.03 (0.03-0.03)

TCAs with opioid or calcium channel blocker (risk of severe constipation)

26649

2.6 (2.6-2.6)

Long-term (>1 month) long-acting benzodiazepines (risk of prolonged sedation, confusion, impaired balance, falls)

15057

1.5 (1.5-1.5)

Long-term (>1 month) neuroleptics (antipsychotics) ( risk of confusion, hypotension, extrapyramidal side-effects, falls)

21012

2.1 (2.1-2.1)

Long- term (>1 month) neuroleptics with parkinsonism (worsen extrapyramidal symptoms)

852

0.1 (0.1-0.1)

Anticholinergics to treat extrapyramidal symptoms of neuroleptic medications (risk of anticholinergic toxicity)

869

0.1 (0.1-1.0)

Phenothiazines with epilepsy (may lower seizure threshold)

448

0.04 (0.04-0.04)

Prolonged use (>1 week) of first-generation anti-histamines (risk of sedation and anti-cholinergic side-effects)

6020

0.6 (0.6-0.6)

TCA’s with cardiac conductive abnormalities

543

0.05 (0.05-0.05)

TCA’s with prostatism or prior history of urinary retention (risk of urinary retention)

2623

0.3 (0.3-0.3)

TCA’s with constipation (likely to worsen constipation)

7279

0.7 (0.7-0.7)

Gastrointestinal System

Prochlorperazine or metoclopramide with parkinsonism (risk of exacerbating parkinsonism)

385

0.04 (0.04)

PPI for peptic ulcer disease at maximum therapeutic dosage for > 8 weeks (dose reduction or earlier discontinuation indicated)

38153

3.7 (3.7-3.8)

Anticholinergic antispasmodic drugs with chronic constipation (risk of exacerbation of constipation)

1208

0.1 (0.1-0.1)

Respiratory system

Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD (unnecessary exposure to long-term side-effects of systemic steroids)

1339

0.1 (0.1-0.1)

Nebulised ipatropium with glaucoma ( exacerbate glaucoma )

20

0

Musculoskeletal system

Long term NSAID use (>3 months) with osteoarthritis (simple analgesics preferable)

12167

1.2 (1.2-1.2)

Warfarin and NSAID use (risk of gastrointestinal bleeding)

2495

0.2 (0.2-0.3)

Non-steroidal anti-inflammatory drug (NSAID) with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent histamine H2 receptor antagonist, PPI or misoprostol (risk of peptic ulcer relapse)

1040

0.1 (0.1-0.1)

NSAID with heart failure (risk of exacerbation of heart failure)

409

0.04 (0.04-0.04)

NSAID with chronic renal failure (risk of deterioration in renal function)

928

0.1 (0.1-0.1)

Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthrtitis or osteoarthritis (risk of major systemic corticosteroid side-effects)

718

0.1 (0.1-0.1)

Long-term NSAID or colchicine for chronic treatment of gout where there is no contraindication to allopurinol (allopurinol first choice prophylactic drug in gout)

2845

0.3 (0.3-0.3)

Urinary System

Antimuscarinic drugs (urinary) with dementia (risk of increased confusion and agitation)

297

0.03 (0.03-0.03)

Antimuscarinic drugs with chronic glaucoma (risk of acute exacerbation of glaucoma)

109

0.01 (0.01-0.01)

Bladder antimuscarinic drugs with chronic constipation (risk of exacerbation of constipation)

3514

0.3 (0.3-0.4)

Bladder antimuscarinic drugs with chronic prostatism (risk of urinary retention)

2791

0.3 (0.3-0.3)

Alpha-blockers in males with frequent incontinence i.e. one or more episodes of incontinence daily (risk of urinary frequency and worsening of incontinence)

1426

0.1 (0.1-0.2)

Alpha-blockers with long-term urinary catheter in situ i.e. more than 2 months (drug not indicated)

31226

3.1 (3.0-3.1)

Endocrine system

Beta-blockers in those with diabetes mellitus and frequent hypoglycaemic episodes (risk of masking hypoglycaemic symptoms)

26563

2.6 (2.6-2.6)

Glibenclamide with type 2 diabetes mellitus (risk of prolonged hypoglycaemia)

981

0.1 (0.1-0.1)

H. Drugs that adversely affect those prone to falls (≥1 fall in past three months)

0.3 (0.3-0.3)

1. Benzodiazepines (sedative, may cause reduced sensorium, impair balance)

3358

0.2 (0.2-0.3)

2. Neuroleptic drugs (may cause gait dyspraxia, Parkinsonism)

2491

3. Firstgeneration antihistamines (sedative, may impair sensorium)

250

0.02 (0.02-0.02)

4. Vasodilator drugs (postural hypotension)

788

0.1 (0.1-0.1)

5. Long-term opiates in those with recurrent falls

10321

1.0 (0.1-1.0)

Two concurrent drugs from the same group- therapeutic duplication (optimization of monotherapy within a single drug class)

121668

11.9 (11.9-12.0)