Polypharmacy in AML: The tip of the Iceberg

摘要

Multiple concomitant medications or polypharmacy is a growing concern among health care providers over recent years. The definition of polypharmcy in literature has ranged from 2 to 7 medications and expanded to include inappropriate medication use and drug interactions resulting in adverse drug reactions (ADRs). Older (>65 years of age) patients are at particularly higher risk of ADRs due to inappropriately prescribed medications and polypharmacy (prevalence of 13-92%) [1] partly due to their altered pharma-cokinetics and multiple co-morbidities. Identifying inappropriate medications in the elderly can be assessed through the Beers Criteria or variations such as the Zhan criteria, HEDIS list, and Medication Appropriateness Index [2-4]. In the general population, the incidence of malignancies increases with advancing age, however the effect of polypharmacy in subjects with cancer has been poorly characterized to date. In fact, only two studies have targeted distinct cancer populations and the results of both studies suggest utilizing polypharmacy as a prognostic/predictive tool. Sasaki et al. found polypharmacy increased irinotecan-related toxicity and Iurlo et al. found comorbidities and polypharmacy negatively impacted success with tyrosine kinase inhibitors for CML [5,6].