Drug use among the home-dwelling elderly: Trends, polypharmacy, and sedation
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Appendix A. Appendix tables 1-2

Table 1. Examples of adverse effects and symptoms associated with medications prescribed for the elderly.

Organ/ symptoms	Adverse effects	Examples of medications	References
Cardiovascular system	Orthostatism	Diuretics, beta blockers, nitrates, vasodilatators	^b
		ACE inhibitors	Cohen et al. 1998
		Dipyridamole	Beers 1997
		Cyclic antidepressants	Glassman et al. 1979
		Antipsychotics	Casey 1997, Bazire 1999
		Anticholinergics^a (list in nervous system section)	Casey 1997, Bazire 1999
	Arrhythmia/ prolongation of QT interval	Antiarrhythmics (quinidine, sotalol, amiodarone), vasodilatators, diuretics, antidepressants (cyclic antidepressants), antisychotics (chlorpromazine, thioridazine, haloperidol), antimicrobials (erythromycin, trimethoprim/sulfa), corticosteroids	O´Brien et al. 1999
		Atypical antipsychotics	Campbell et al. 1999
		Terfenadine, astemizole	Slater et al. 1999
		Anticholinergics^a (list in nervous system section)	Slater et al. 1999
	Bradycardia	Beta blockers, digoxin	^{b, c}
	Heart failure/insufficiency	Disopyramide, beta blockers, calcium channel blockers, NSAIDs	^{b, c}
Nervous system	Dry mouth, constipation,	Examples of drugs with anticholinergic properties^a:
	urinary retention,	- nitrate, nifedipine, furosemide, captopril, nortriptyline, hydroxyzine,	Tune & Bylsma 1991^a,
	orthostatism, tachycardia, blurring of vision,	diphenhydramine, ranitidine, cimetidine, warfarin, dipyridamole, theophylline, prednisolone, codeine	Tune et al. 1992^a
	glaucoma, cognitive	- antipsychotics, cyclic antidepressants	Roe et al. 2002, ^b
	decline	- disopyramide, imipramine, amitriptyline, doxepin, olanzapine, atropine, antihistamines, oxybutynin, orphenadrine, antiemetics, antiparkinsonian drugs, scopolamine	Roe et al. 2002
	Sedation	Antipsychotics, hypnotics/sedatives, most antidepressants, opioids	^b
		Old antihistamines	Slater et al. 1999
		Some new antihistamines (cetirizin)	Blokland et al. 2001
	Cognitive decline or delirium	Anticholinergics^a
		Antihypertensives, antiarrhythmics, digoxin, hypnotics/sedatives, cyclic antidepressants, conventional antipsychotics, anticonvulsants, antiparkinsonian drugs, NSAIDs, paracetamol overdosage, opioids, histamine H₂ - receptor antagonists, insulin, antibiotics, aminophylline, corticosteroids, antineoplastic agents	Bowen & Larson 1993
		Hydroxyzine, disopyramide, oxybutynin	Beers 1997
		Benzodiazepines	Rawson & Rawson 1999
		NSAIDs	Goodwin & Regan 1982, Hoppman et al. 1991, Karplus & Saag 1998
		Scopolamine	Miller et al. 1988
	Depression	Benzodiazepines	Hall & Joffe 1972, Rawson & Rawson 1999
		Antipsychotics	Weinstein 1980
		Opioids	Weissman et al. 1976,
		Levodopa	b
		Ibuprofen, aspirin	Blechman et al. 1975
		Beta blockers, corticosteroids	b
	Depression/ paranoia	NSAIDs	Browning 1996
	Neuropathias	Gold preparations, nitrofurantoin, antineoplastic agents, tricyclic antidepressants	^c
		Statins	Weimer 2003
	Myopathias	Statins	^b
	Psychosis, aseptic meningitis	NSAIDs	Hoppman et al. 1991
	Extrapyramidal symptoms	Neuroleptics	Campbell et al. 1999
		Metoclopramide	b
	- tardive dyskinesia/tremor	Neuroleptics	Rapoport et al. 1998, Jeste et al. 1999
	Malignant neuroleptic syndrome	Neuroleptics	^b
	Serotonin syndrome	SSRIs	b
	Changes in taste	Anticholinergics^a, metronidazole, diltiazem, nifedipine	c
Gastrointestinal system	Gastrointestinal ulcer,	NSAIDs	O´Brien 1986, ^c
	gastritis	Glucocorticoids	^b
	Constipation	Anticholinergics^a, calcium channel blockers, opioids, sucralfate	^b
		Aluminium/calcium containing antacids	^c
		Antipsychotics, cyclic antidepressants	Bazire 1999
	Diarrhoea	Antibiotics, magnesium-containing antacids	^c
	Incontinence	Hypnotics/sedatives, lithium	b
	Nausea	Erythromycin, opioids, digoxin, iron preparations	^c
		Anti-dementia drugs	^b
		SSRIs	Edwards & Anderson 1999
		Benzodiazepines	Rawson & Rawson 1999
	Liver effects
	- hepatitis	ASA, phenytoin, paracetamol	^c
	- other liver adverse	Statins	^b
	Effects	NSAIDs	Nuki 1990
	Effects	Glucocorticoids, valproic acid, estrogens, oral blood glucose-lowering drugs, conventional antipsychotics	^c
	Hyperplastic gingiva	Phenytoin, nifedipine	^c
	Pharyngeal fungus	Inhaled glucocorticoids	^c
Urinary system	Urinary retention	Anticholinergics^a, hypnotics/sedatives, opioids, diuretics	^b
	Urinary retention	Antipsychotics, cyclic antidepressants	Bazire 1999
	Urinary incontinence	Hypnotics/sedatives, lithium, diuretics	^b
	Kidney insufficiency	NSAIDs	O´Brien 1986, Nuki 1990
	Kidney insufficiency	NSAIDs, paracetamol, antibiotics, allopurinol, diuretics, ACE inhibitors, phenytoin, gold preparations	^c
Visual	Eye lens damage	Glucocorticoids	^c
Visual	Blurring of vision	Anticholinergicsa
Hearing	Ototoxic	Salicylates, furosemide	^c
Pulmonary system	Coughing	ACE inhibitors	^c
	Obstruction	Beta blockers, opioids, ASA, cephalosporins, penicillin	c
	Respiratory insufficiency	Benzodiazepines, opioids	Rawson & Rawson 1999, ^c
	Mucus in respiratory organs	Anticholinergics^a	^c
	Immmunologic reactions	Nitrofurantoin	^c
	Fibrosis in pulmonum	Antineoplastic agents	^c
	Vasculitis	Gold preparations, nitrofurantoin, phenytoin	^c
Blood system	Bleeding	Warfarin, ASA, NSAIDs	^c
	Blood cell damage	Antibiotics, gold preparations, antineoplastic agents, NSAIDs, diuretics, quinidine	^c
	Blood cell damage	Clozapine, mianserin, conventional antipsychotics	^b
Skin	Eczema	Amoxicillin, cephalosporins, trimethoprim/sulfa, carbamatzepine	^c
Miscellanous organs/symptoms
Headache		Nitrates	^b
Electrolyte disturbances	Hyponatremia	Diuretics, carbamazepine, oxcarbazepine	^b
	(delirium, arrhythmia, tiredness, weakness)	SSRIs	Pradalier et al. 1998, Odeh et al. 1999, Wilkinson et al. 1999
	Hypomagnesemia, Hypokalemia (weakness)	Diuretics	^b
	Hypocalcemia (convulsiones)	Diuretics	^b
Allergy		Herbal drugs	Enkovaara 1999
Metabolic disturbances	Glucose balance changes
	- hyperglycosemia	Diuretics, corticosteroids, antipsychotics	^b
	- hypoglycosemia	Sulphonamides, insulin, other blood glucose-lowering drugs	^b
	Body weight gain	Second-generation histamine H1 receptor antagonists	Slater et al. 1999
	Body weight gain	Antipsychotics, mirtazapine	^b
	Hyperlipidemia	Antipsychotics	Koro et al. 2002
Falls	Contusions, fractures	Diazepam, diltiazem, diuretics, laxatives	Cumming 1991
		Vasodilatators, diuretics	Myers et al. 1991
		Neuroleptics, benzodiazepines	Aisen et al. 1992
		Anxiolytics, antipsychotics	Malmivaara et al. 1993
		Antidepressants	Ruthazer & Lipsitz 1993
		Benzodiazepines, analgesics, digoxin	Ryynänen et al. 1993, Ryynänen et al. 1994
		Sedatives	Tinetti et al. 1994
		Benzodiazepines	Sorock & Shimkin 1988, Herings et al. 1995
		Long-acting benzodiazepines, antidepressants	Lord et al. 1995
		Antidepressants	Ebly et al. 1997
		Diuretics, antihypertensives, digoxin, vasodilatators, analgesics (NSAIDs), psychotropics (antidepressants)	Cumming 1998
		SSRIs	Liu et al. 1998
		Psychotropic-opioid combinations	Weiner et al. 1998
		Diuretics, type I a antiarrhythmics, digoxin, SSRI, tricyclic antidepressants,	Thapa et al. 1998, Leipzig et al.
		neuroleptics, benzodiazepines, anticonvulsants	1999a & 1999b
		All psychotropics, including non-benzodiazepine hypnotics	Wang et al. 2001
^aAnticholinergic effects of many drugs and their metabolites are unknown. Thus, this list of drugs with these effects may be far away from the real clinical situation.^bPharmaca Fennica 2001, ^cHimberg & Kuitunen 2002. ACE = angiotensin-converting enzyme, SSRI = selective serotonin reuptake inhibitor, NSAID = nonsteroidal anti-inflammatory drug, ASA = acetylsalicylic acid.

Table 2. Division of the home-dwelling elderly in community in 1998-99 (the corresponding results in 1990-91 are given in parenthesis) by the number of drugs in use and by difficulties or dependence in ADL, mobility, or IADL.

Difficulties or dependence in activities	Number of drugs						p-value*
	0		1–5		> 5
	%	(%)	%	(%)	%	(%)
Number of drug users	141	(252)	756	(659)	300	(220)
Difficulties or dependence in ADL:							*
Getting in and out of bed	2	(2)	5	(15)	19	(36)
Using the lavatory	4	(2)	14	(12)	31	(30)
Dressing and undressing	2	(3)	7	(14)	24	(31)
Washing and bathing	2	(3)	9	(17)	27	(37)
Difficulties or dependence in mobility:							*
Walking between rooms	3	(6)	13	(22)	32	(49)
Using stairs	9	(10)	35	(36)	62	(72)
Moving outdoors	8	(8)	29	(31)	57	(66)
Walking at least 400 m	8	(8)	27	(32)	57	(69)
Difficulties or dependence in IADL:							*
Light housekeeping tasks	5	(5)	19	(24)	46	(57)
Heavy housekeeping tasks	16	(12)	41	(42)	73	(84)
Carrying a heavy load	11	(12)	36	(35)	67	(75)
Cutting one`s toe nails	12	(9)	32	(33)	56	(68)
Handling financesa	5		15		36
Use of public transportationa	6		16		43
Taking care of one’s medication^a	14		82		96
Ability to use the phonea	2		5		16
* p-values are based on Chi-square test, p < 0.0001. ^aAsked from participants only in 1998–99.