Prediction and prevention of adverse drug events

Polypharmacy, i.e. use of multiple medicinal products at the same time, is widespread in current drug therapy framework. Management of complex diseases often requires concomitant use of products for synergistic actions, while multiple preventive medications create situations in which pharmacotherapy of any additional condition results in polypharmacy. Particularly, advanced age is often associated with a number of comorbidities, which require the use of several drugs. Consequently, 75 to 80 year old subjects have an average of 10 drugs in regular use. As a drawback, polypharmacy is a major reason for serious or fatal adverse drug events (ADEs), constituting a major concern in all pharmacotherapy. The incidence of ADEs is fourth of the leading causes of death in the Western world and ADEs contribute to significant economic losses and increased hospitalization.

Polypharmacy is usually managed by following development of subject’s symptoms and disease progression, and adjusting drug dosing and selection accordingly. However, this cannot usually take into consideration many subject-centered treatment uncertainties and there are situations in which more objective ascertainment of individual drug use would be desirable. In addition, medication errors and patient incompliance are often neglected in medication reconciliation and remain unidentified in acute hospitalizations and readmissions.