Drug safety profiles in geriatric patients with Parkinson's disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

Abstract

To reduce potentially inappropriate medications, the FORTA (Fit fOR The Aged) concept classifies drugs in terms of their suitability for geriatric patients with different labels, namely A (indispensable), B (beneficial), C (questionable), and D (avoid). The aims of our study were to assess the medication appropriateness in PD inpatients applying the FORTA list and drug-drug interaction software, further to assess the adequacy of FORTA list for patients with PD. We retrospectively collected demographic data, comorbidities, laboratory values, and the medication from the discharge letters of 123 geriatric inpatients with PD at the university hospital of Hannover Medical School. Patients suffered on average from 8.2 comorbidities. The majority of the medication was labeled A (60.6% of PD-specific and 40.9% of other medication) or B (22.3% of PD-specific and 26.9% of other medication). Administered drugs labeled with D were amantadine, clozapine, oxazepam, lorazepam, amitriptyline, and clonidine. Overall, 545 interactions were identified, thereof 11.9% severe interactions, and 1.7% contraindicated combinations. 81.3% of patients had at least one moderate or severe interaction. The FORTA list gives rational recommendations for PD-specific and other medication, especially for general practitioners. Considering the demographic characteristics and the common multimorbidity of geriatric PD patients, this study underlines the importance of awareness, education, and preventive interventions to increase drug safety.

Keywords: Drug safety; FORTA prescribing list; Geriatric patients; Multimorbidity; Parkinson’s disease; Polypharmacy.

Fig. 1

Comorbidities of geriatric PD patients (n = 123). a Shows the number of major comorbidities in different medical disciplines according to the first level of ICD-10, plotted as absolute numbers. Note, the number of comorbidities can exceed the number of patients due to co-occurrence of several comorbidities in an individual patient. b Shows the number of the most common comorbidities on the second level of ICD-10 as absolute numbers

Fig. 2

FORTA labelling of prescribed drugs. a FORTA labelling of PD-specific drugs in percentages of the different FORTA labels of all PD-specific drugs. b FORTA labelling of other drugs in percentages of the different FORTA labels of all other drugs

Fig. 3

Drug-drug interactions. The figure shows the absolute numbers of interactions divided into the different categories of severity. The x axis lists the interactions with increasing severity from “disputed evidence” to “contraindicated combination”