A list of dangerous medicines for clinicians to scrutinise

Australia has a new resource for spotting medications that are regularly prescribed to older people, but which may be dangerous.

The new list of “potentially inappropriate medicines”, or PIMs, was developed by a team of more than 30 experts, and contains 16 medications or classes of medication.

It’s designed to help clinicians avoid prescribing drugs where the risks outweigh the benefits – and instead choose safer alternatives.

PIMs lists are common in several countries, but it’s been 15 years since Australia had an updated version.

“Just because a particular medication is on this PIMs list, it doesn’t make it completely unsafe,” lead researcher Dr Kate Wang, a senior lecturer in pharmacy at RMIT University, tells Cosmos.

All of the medications on the list are prescribed because there’s good evidence they can provide benefits, says Wang.

But these medications can have dangerous side effects – up to and including death, in some circumstances, and they can interact with other drugs. This is particularly important for older people, as they typically are prescribed more medications and have more ongoing health conditions.

“The idea of having a list like this is so that people are aware, and if anyone is on these medications, it can be regularly reviewed by their doctors or pharmacists. So that when it is no longer needed, or if there’s a safer alternative available, they can consider that,” says Wang.

One example is some non-steroidal anti inflammatory drugs (NSAIDs) like ibuprofen, which the researchers say should be avoided in older people with conditions like a history of gastrointestinal bleeding, poor renal function, or heart failure. Instead, the list suggests using paracetamol.

The full list of medications and alternatives is published in Internal Medicine Journal.

The researchers developed the list by gathering a committee of 33 experts in geriatrics, medicine, pharmacology, and epidemiology.

They used a discussion method called the Delphi technique to establish which medicines were particularly risky in the Australian context. Wang says that the Delphi technique is used by researchers to reach a consensus on certain topics.

Person standing in pharmacy smiling at camera
Lead researcher Dr Kate Wang in the mock dispensary where pharmacy students at RMIT University undertake some of their classes. Credit: RMIT University / Ant Bragaglia

“In this case, we started off with about 130 medications or medication classes that have appeared on international PIMs lists, and we asked the panel of experts in questionnaires which medications they thought are inappropriate in Australia, under what circumstances are they inappropriate, and if there are any safer alternatives,” says Wang.

In this case, the researchers considered “older people” as Australians aged over 65.

“After that, we compiled the results, saw which ones had reached agreement, and then we repeated that process until we reached consensus,” says Wang.

While international PIMs lists are a good starting point for finding these medications, the researchers believe that the Australian healthcare setting needs its own list.

“We did a study previously that looks at how applicable pre-existing PIMs lists are to the Australian healthcare setting, and we found that none of them were 100% applicable,” says Wang.

“Healthcare is unique to each country – for example, the medications that are available, the dosage forms, the strength of some things, and prescribing guidelines.”

Wang says that their list should be monitored and updated when there are big changes in the medication market.

The researchers are now investigating how many older Australians are being prescribed these PIMs. In other countries, between 20% and 70% of older people have been prescribed medications on their own PIMs lists.

Sign up to our weekly newsletter

Please login to favourite this article.