Comorbidities, Age, and Polypharmacy Limit the Use by US Older Adults with Nocturia of the Only FDA-approved Drugs for the Symptom

Affiliations

¹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
² Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
³ Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Brookhaven, GA, USA.
⁴ Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA; Division of Gerontology, Geriatrics and Palliative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁶ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
⁷ Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
⁸ College of Pharmacy, University of Georgia, Athens, GA, USA.
⁹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Brookhaven, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of General Internal Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA. Electronic address: tmjohns@emory.edu.

PMID: 33257091
PMCID: PMC8811749
DOI: 10.1016/j.clinthera.2020.11.003

Comorbidities, Age, and Polypharmacy Limit the Use by US Older Adults with Nocturia of the Only FDA-approved Drugs for the Symptom

Kara Suvada et al. Clin Ther. 2020 Dec.

. 2020 Dec;42(12):e259-e274.

doi: 10.1016/j.clinthera.2020.11.003. Epub 2020 Nov 28.

Authors

Affiliations

¹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
² Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
³ Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Brookhaven, GA, USA.
⁴ Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA; Division of Gerontology, Geriatrics and Palliative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁶ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
⁷ Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
⁸ College of Pharmacy, University of Georgia, Athens, GA, USA.
⁹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Brookhaven, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of General Internal Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA. Electronic address: tmjohns@emory.edu.

PMID: 33257091
PMCID: PMC8811749
DOI: 10.1016/j.clinthera.2020.11.003

Abstract

Purpose: The goal of this study was to determine if the US adult population with nocturia (waking from sleep at night to void) can easily take medications (desmopressin acetate) approved by the US Food and Drug Administration for nocturia. The study examined: (1) the prevalence of comorbid conditions, laboratory abnormalities, and concomitant medications that increase risk of desmopressin use; and (2) whether these factors are associated with age or nocturia frequency.

Methods: Using a cross-sectional analysis of four US National Health and Nutrition Examination Survey (NHANES) waves (2005-2012), a total of 4111 participants aged ≥50 years who reported ≥2 nightly episodes of nocturia were identified. The main outcome was frequency of contraindications and drug interactions as described in US Food and Drug Administration-approved prescribing information. These prescribing concerns were matched to examination findings, medical conditions, concomitant medications, and laboratory results of NHANES participants. The associations between prescribing concerns and nocturia severity and age groups were examined.

Findings: The mean participant age was 65.7 years (95% CI, 65.3-66.1), and 45.5% were male. Desmopressin prescribing concerns were present in 80.5% (95% CI, 78.0-82.9) of those ≥50 years of age with nocturia; 50.0% (95% CI, 47.0-53.0) had contraindications, and 41.6% (95% CI, 39.3-44.0) took a concomitant drug that could increase risk of low serum sodium. Desmopressin contraindications were higher with older age (P < 0.001) and present in 73.2% (95% CI, 69.3-77.1) of those ≥80 years of age.

Implications: Using NHANES data, this study showed that older US adults with nocturia have a high prevalence of medical conditions, concomitant medications, and baseline laboratory abnormalities that likely increase the risk of potentially severe adverse side effects from desmopressin use. A medication designed and approved for a clinical symptom that is most common in older adults could not be taken by most of the older adults with the symptom.

Keywords: aged or elderly; comorbidity; medications; polypharmacy; risk factors; safety.

Published by Elsevier Inc.

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Comment in

Contraindications prevent desmopressin use in patients with nocturia.
Thomas T. Thomas T. Nat Rev Urol. 2021 Feb;18(2):72. doi: 10.1038/s41585-021-00423-x. Nat Rev Urol. 2021. PMID: 33408353 No abstract available.

References

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Comorbidities, Age, and Polypharmacy Limit the Use by US Older Adults with Nocturia of the Only FDA-approved Drugs for the Symptom

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Comorbidities, Age, and Polypharmacy Limit the Use by US Older Adults with Nocturia of the Only FDA-approved Drugs for the Symptom

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