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

From: Potentially inappropriate prescribing among older people in the United Kingdom

Criteria description Number of patients (N = 1,019,491) % of patients (95% CIs)
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)
  1. aItalised text in brackets represents the potential risk associated with the PIP indicators.