PIMs+

wdt_ID db_id Class generic PIMs+ Prescrire BBW INGREDIENT_1 ING_RXCUI_1 INGREDIENT_2 ING_RXCUI_2 QT Route Combined DTA CLQTS class_long CKD Dementia ACB SS HOTN PIMs+ Note eGFR Match_D Prescrire_drug_name PRESCIRE Resources
1 DB00106 Antineoplastics abarelix 0 injection PR PR Score 0
2 DB00054 Anti-platelet abciximab abciximab 83929 Anti-platelet: glycoprotein platelet inhibitors Score 0 Late-stage: cease anti-platelet agents
3 DB05812 Antineoplastics abiraterone abiraterone 1100072 oral CR CR Score 0
4 DB01193 Cardiovascular agents acebutolol Acebutolol 149 Cardiovascular agents: beta-adrenergic blockers Score 0

Beta-blockers should not be used as 1st-line therapy for uncomplicated hypertension in patients >60 years (Canada) unless there are comorbid conditions which benefit from beta-blockers. (Beta-blockers are highly effective agents in patients with other indications (such as post-myocardial infarction for a time-limited period, or heart failure with reduced ejection fraction).

Late-stage: cease antihypertensive agents Beta blockers
5 DB06736 Analgesics: NSAIDs aceclofenac 0 Analgesics: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Score 0

Use may increase risk of serious cardiovascular thrombotic effect, myocardial infarction, increased risk of hypertension, or stroke, and should be used with caution or avoided in patients with heart failure. Use may also increase risk of central nervous system effects, renal injury, and serious or fatal gastrointestinal adverse events, including bleeding, ulceration and perforation.

Use of gastroprotective agents (e.g. PPIs, misoprostol) should be used to help reduce risk of gastrointestinal adverse effects. Use should be avoided in those with gastrointestinal ulcers. Lowest possible effective doses should be used short-term.

Patients over the age of 75 may have reduced ability to metabolize NSAIDS and thus are at greater risk of adverse events.

Should be avoided in those with stage 4 or higher kidney disease, or where creatinine clearance is <30mL/min.

Avoid continuous use unless other alternatives are not effective and patient can take gastroprotective agent (PPI or misoprostol). Increased risk for gastrointestinal bleeding or peptic ulcer disease.

Avoid continuous use unless other alternatives are not effective and patient can take gastroprotective agent (PPI or misoprostol). Increased risk for gastrointestinal bleeding or peptic ulcer disease.

Aceclofenac

Oral aceclofenac and oral diclofenac cause more cardiovascular adverse effects (including myocardial infarction and heart failure) and more cardiovascular deaths than other equally effective NSAIDs (Prescrire Int no. 167, 210; Rev Prescrire no. 362, 374).

Although nonsteroidal anti-inflammatory drugs (NSAIDs) share a similar adverse effect profile, some expose patients to less risk than others. When paracetamol proves inadequate, ibuprofen and naproxen, used at the lowest effective dose and for the shortest possible period, are the least risky options.

NSAID - Non Cox2
6 DB13783 Analgesics: NSAIDs acemetacin 0 Analgesics: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Score 0

Use may increase risk of serious cardiovascular thrombotic effect, myocardial infarction, increased risk of hypertension, or stroke, and should be used with caution or avoided in patients with heart failure. Use may also increase risk of central nervous system effects, renal injury, and serious or fatal gastrointestinal adverse events, including bleeding, ulceration and perforation.

Use of gastroprotective agents (e.g. PPIs, misoprostol) should be used to help reduce risk of gastrointestinal adverse effects. Use should be avoided in those with gastrointestinal ulcers. Lowest possible effective doses should be used short-term.

Patients over the age of 75 may have reduced ability to metabolize NSAIDS and thus are at greater risk of adverse events.

Should be avoided in those with stage 4 or higher kidney disease, or where creatinine clearance is <30mL/min.

Avoid continuous use unless other alternatives are not effective and patient can take gastroprotective agent (PPI or misoprostol). Increased risk for gastrointestinal bleeding or peptic ulcer disease.

NSAID - Non Cox2
7 DB01614 Antipsychotics acepromazine 0 Antipsychotics Score 0

Antipsychotics should be avoided in elderly patients with delirium, dementia, dementia-related psychosis, and dementia-related behavioral problems as there is an increased risk of cognitive impairment, tardive dyskinesia, neuroleptic malignant syndrome, stroke, and death. May also increase risk of hyponatremia or SIADH.

Antipsychotics (with the exception of quetiapine, clozapine and pimavanserin) should be avoided in Parkinson's disease due to potential worsening of motor symptoms. Should be avoided in patients with history of syncope, falls or fractures, due to potential for impaired motor function, orthostatic hypotension and bradycardia. Should only be used for indications of schizophrenia and bipolar disorder without dementia. Antipsychotics with strong anticholinergic properties should be avoided in patients with obstructive disease of the genitourinary tract. Antipsychotic use during chemotherapy to prevent vomiting, if used on a short-term basis, may be appropriate.

Avoid, except in schizophrenia or bipolar disorder, or for short term use as antiemetic during chemotherapy. Increased risk of cerebrovascular accident (stroke) and greater rate of cognitive decline in patients who have dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or patient is threatening to harm self or other people.

Antipsychotics
8 DB00819 Antiepileptics acetazolamide Acetazolamide 167 Antiepileptics: Carbonic anhydrase inhibitor anticonvulsants Score 0

Caution should be used when prescribing these drugs for older adults. CNS effects of antiepileptics may cause ataxia, sedation, syncope, impaired cognition and confusion, dizziness, and blurred vision, and impaired psychomotor function all of which may place patients at an increased risk of falls and/or fractures.

Late-stage: cease antihypertensive agents; only use diuretics for symptomatic management of heart failure Antiepileptics
9 DB00819 Cardiovascular agents acetazolamide Acetazolamide 167 Cardiovascular agents: diurectics, carbonic anhydrase inhibitors Score 0

Caution should be used when prescribing these drugs for older adults. CNS effects of antiepileptics may cause ataxia, sedation, syncope, impaired cognition and confusion, dizziness, and blurred vision, and impaired psychomotor function all of which may place patients at an increased risk of falls and/or fractures.

Late-stage: cease antihypertensive agents; only use diuretics for symptomatic management of heart failure Antiepileptics
10 DB01063 Antipsychotics acetophenazine 0 Antipsychotics Score 0

Antipsychotics should be avoided in elderly patients with delirium, dementia, dementia-related psychosis, and dementia-related behavioral problems as there is an increased risk of cognitive impairment, tardive dyskinesia, neuroleptic malignant syndrome, stroke, and death. May also increase risk of hyponatremia or SIADH.

Antipsychotics (with the exception of quetiapine, clozapine and pimavanserin) should be avoided in Parkinson's disease due to potential worsening of motor symptoms. Should be avoided in patients with history of syncope, falls or fractures, due to potential for impaired motor function, orthostatic hypotension and bradycardia. Should only be used for indications of schizophrenia and bipolar disorder without dementia. Antipsychotics with strong anticholinergic properties should be avoided in patients with obstructive disease of the genitourinary tract. Antipsychotic use during chemotherapy to prevent vomiting, if used on a short-term basis, may be appropriate.

Avoid, except in schizophrenia or bipolar disorder, or for short term use as antiemetic during chemotherapy. Increased risk of cerebrovascular accident (stroke) and greater rate of cognitive decline in patients who have dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or patient is threatening to harm self or other people.

Antipsychotics
Class generic