From: The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria
Original source(s) for criteria | Section | Rationale |
---|---|---|
Gastro-Intestinal System | ||
[15] | Other than for opioid-induced constipation, stimulant laxatives (e.g. bisacodyl, senna) should not be prescribed as first-line treatment in constipation for greater than four weeks. | Stimulant laxatives are not suitable for continuous long-term use, other than for opioid induced constipation. |
[14] | Proton pump inhibitors (PPIs) (e.g. esomeprazole, omeprazole) should not be prescribed at doses above the recommended maintenance dosage for greater than eight weeks. | A dose reduction or discontinuation is indicated since there is no therapeutic benefit observed with the use of higher doses of PPIs long-term (unless treatment is indicated for rare conditions e.g. Zollinger-Ellison syndrome). |
Added by Project Steering Group[21] | Esomeprazole or omeprazole should not be used in combination with clopidogrel. | Esomeprazole and omeprazole may reduce the anti-platelet effect of clopidogrel and therefore should not be used in combination with clopidogrel. Other proton pump inhibitors or H 2 -receptor antagonists are available which do not have the same potential for interaction. |
Cardiovascular System | ||
The use of alpha-adrenoceptor blocking drugs (e.g. doxazosin, prazosin) as monotherapy for hypertension, should be avoided. | Alpha-adrenoceptor blocking drugs increase the risk of orthostatic hypotension. | |
[14] | Aspirin doses should not exceed 150 mg/day for anti-platelet therapy. | Doses exceeding 150 mg/day show no evidence for increased efficacy and will increase the risk of bleeding. |
Cardio-selective calcium-channel blockers (e.g. verapamil, diltiazem) should not be used in combination with beta-adrenoceptor blocking drugs. | Concomitant use increases the risk of atrioventricular block and myocardial depression. | |
The use of oral short-acting dipyridamole should not be used as monotherapy in antiplatelet treatment. | Oral short-acting dipyridamole may cause orthostatic hypotension; more effective alternatives available. | |
Respiratory System | ||
First generation antihistamines (e.g. chlorphenamine, promethazine) should not be used as first-line agents for greater than seven days. | First generation antihistamines may cause addiction and/or exert anticholinergic properties causing unwanted side-effects e.g. constipation, drowsiness, psychomotor impairment. | |
Theophylline should not be used as monotherapy for asthma or chronic obstructive pulmonary disease. | Theophylline is associated with an increased risk of arrhythmias. | |
[14] | A concomitant bisphosphonate should be prescribed if oral corticosteroids are used long-term (greater than three months). | Long-term use of an oral corticosteroid increases the risk of osteoporosis and subsequent bone fracture. |
Added by Project Steering Group[22] | Mucolytic agents (e.g. carbocisteine, mecysteine) should not be used routinely in stable chronic obstructive pulmonary disease. | There is little benefit from the use of mucolytic agents in stable chronic obstructive pulmonary disease. |
Central Nervous System | ||
[12] | Selective serotonin reuptake inhibitors (e.g. citalopram, fluoxetine) should not be used in combination with venlafaxine. | Concomitant use may lead to the development of serotonin syndrome. |
Tricyclic antidepressants (TCAs) (e.g. amitriptyline, nortriptyline) should not be used as first-line in treatment of depression. | TCAs are associated with unwanted peripheral anticholinergic side-effects e.g. constipation, dry mouth and central anticholinergic side-effects e.g. drowsiness. | |
Benzodiazepines (e.g. nitrazepam, temazepam) should not be used long-term (greater than four weeks). | Long-term use of benzodiazepines increases the risk of dependency. Benzodiazepine related adverse effects include daytime sedation, cognitive impairment, agitation, irritability. | |
Non-benzodiazepine hypnotics (zolpidem, zaleplon, zopiclone) should not be used long-term (greater than 4 weeks). | Non-benzodiazepine hypnotics have adverse events similar to those of benzodiazepines with minimal improvement in sleep latency and duration. | |
[11] | Carbamazepine should not be used in combination with clarithromycin or erythromycin. | Clarithromycin and erythromycin inhibit the metabolism of carbamazepine therefore increasing the risk of adverse effects e.g. headache, drowsiness, nausea. |
Strong opioids (e.g. buprenorphine, diamorphine, fentanyl, morphine, oxycodone) should not be prescribed without the co-prescribing of laxatives. | Strong opioids are likely to cause constipation. | |
Infections | ||
Nitrofurantoin should not be prescribed for greater than 7 days for the management of uncomplicated lower urinary-tract infections. | Potential for pulmonary toxicity; safer alternatives available. | |
Endocrine System | ||
In relation to the management of diabetes, the use of oral long-acting sulfonylureas (glibenclamide) should be avoided. | Oral long-acting sulfonylureas have a prolonged half-life and can cause prolonged hypoglycaemia or syndrome of inappropriate antidiuretic hormone (ADH) secretion. | |
Musculoskeletal System | ||
Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. celecoxib, diclofenac, naproxen) should not be used long-term (greater than three months). | Long-term NSAID treatment should be reviewed periodically due to increased risk of thrombotic effects, and the lowest effective dose should be prescribed for the shortest period. | |
Unless adequate gastro-intestinal protection is provided with either a proton pump inhibitor or H 2 -receptor antagonist, non-steroidal anti-inflammatory drugs should not be used in combination with: | Concomitant use increases the risk of gastro-intestinal bleeding. | |
a. Low-dose aspirin. | ||
b. Selective serotonin re-uptake inhibitors. | ||
Duplication of drug classes | ||
The use of two or more drugs from the same pharmacological class should be avoided, unless used for additive effects in line with current clinical guidelines. | Possible unwanted duplication of effect, increasing risk of side effects and adverse events. | |
For example: Avoid duplication of opioid analgesics, non-steroidal anti-inflammatory drugs, benzodiazepines. | An example of an exception includes: duplicate beta 2 agonists (provided one is short-acting and one is long-acting) for the management of asthma or chronic obstructive pulmonary disease. |