Acute illness has been found to increase the likelihood of drug-drug interactions and polypharmacy, and COVID-19 appears to offer no exception to that rule. A new study across long-term care facilities has found that residents with the disease are especially vulnerable to these risks.
Investigators examined records for all residents diagnosed with COVID-19 in a single chain of 41 facilities in Texas. Over a six-month period, they looked at new medications, increases in dosage, drug-drug interactions and evidence of whether newly initiated drugs were stopped after illness resolved.
More than half of the residents with COVID-19 were treated with new medications, with an average of 2.6 drugs being initiated, they found. Antimicrobials were the drugs most commonly prescribed.
In addition, approximately one-third of the original study cohort had at least one new medication still recorded at 30 days after their COVID-19 diagnosis. What’s more, nearly 20% experienced clinically significant drug-drug interactions.
Drug cocktails and med errors
During the pandemic, many long-term care facility residents have received treatment with bundles of medications, including antibiotics, anticoagulants, systemic corticosteroids, inhaled therapies and nutritional supplements — some of which were shown to be beneficial, and some of which had no evidence of benefit, according to the researchers.
These COVID-19 cocktails can increase the risk of medication errors, drug interactions and pill burden, not to mention raising the potential that the facility receives a state survey tag relating to unnecessary drugs, lead author Amie Taggart Blaszczyk, Pharm.D., of Texas Tech University Health Sciences Center School of Pharmacy, reported.
Although the current study was limited to one state and investigators were hampered by a lack of efficacy or safety outcomes for the COVID-19 drug regimens, the findings are consistent with other analyses, the authors noted.
Opportunities for change
The study results highlight an opportunity to mitigate the risks for polypharmacy — not only related to COVID-19 but due to other acute illnesses among long-term care residents, Blaszczyk and colleagues added.
Stop dates should be used when medications are prescribed for acute illness, they said. This is true not only for antimicrobials (such as antibiotics), but for anticoagulants, inhalers, supplements, and PRNs [prescriptions taken as needed] in cases of time-limited illness, they added. Researchers also encouraged prescribers to review residents’ current medication regimens before any new therapies are begun.
“Considerations of pill burden, [drug-drug interactions] and drug-disease interactions should be as important as symptom control,” they wrote. This is especially important when using as-yet unproven therapies for treatment or prevention of an acute illness such as COVID, they added.
“Polypharmacy can lead to adverse outcomes, and a more cautious and evidence-based approach for treating COVID-19, or any acute illness, is needed,” they concluded.
Full findings were published in JAMDA.
Antipsychotic reduction in LTC leads to drug substitutions, more delusions diagnoses
Stable use of antipsychotics in long-term care during pandemic ‘reassuring’: study