Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons

Area of Science:

• Geriatric Medicine
• Urology
• Pharmacology

Background:

• Medication management in older patients requires careful consideration of drug appropriateness.
• Alpha-blockers and 5-alpha-reductase inhibitors (5-ARIs) are commonly prescribed for benign prostate hyperplasia (BPH).
• Geriatricians suspect these drugs increase fall risk and drug interactions in the elderly, but evidence is limited.

Purpose of the Study:

• To evaluate the overprescription of potentially inappropriate alpha-blockers and 5-ARIs for BPH in patients aged 75 years and older.
• To assess the association between potentially inappropriate urologic medication use and adverse events like falls and drug interactions.

Main Methods:

• A descriptive study was conducted in a geriatric academic center.
• 117 patients (≥75 years) receiving alpha-blockers or 5-ARIs for BPH were included.
• An 8-item checklist based on SmPC and EAU guidelines was used to identify potentially inappropriate prescriptions.

Main Results:

• 71.8% of patients received at least one potentially inappropriate urologic medication, predominantly alpha-blockers (91.7% of inappropriate prescriptions).
• Patients with potentially inappropriate prescriptions had more frequent urological assessments, pharmacological interactions (orthostatic hypotension, arrhythmia), and a history of falls.
• The misuse group showed a 3.22-fold increased risk of falls (P=.039).

Conclusions:

• Nearly 72% of older individuals received potentially inappropriate BPH medications, mainly alpha-blockers.
• Potentially inappropriate BPH prescriptions were significantly associated with an increased risk of falls.
• Improved medication management strategies are needed for older patients with BPH.