Geneesmiddelgebruik, ondervoeding en deficiënties bij ouderen

Over het effect van geneesmiddelgebruik op de voedingsstatus bij ouderen is relatief weinig bekend. Ondanks de hoge prevalentie van ondervoeding en deficiënties in deze kwetsbare leeftijdsgroep, worden de klinische gevolgen van voedingstekorten bij oudere patiënten vaak niet opgemerkt, of gezien als symptomen van ouderdom of comorbiditeit. Daarnaast is in geneesmiddelonderzoek evaluatie van voeding-geneesmiddelinteracties (VGI's) niet verplicht. Vijf verschillende klassen van VGI's worden besproken: het effect van nutriënten, voeding of voedingstoestand op geneesmiddelwerking en het effect van geneesmiddelgebruik op voedingstoestand of deficiënties, met de focus op vitamine D, foliumzuur, magnesium en vitamine B12. Deze systematische benadering van VGI's is een tool voor uitbreiding van dit kennisgebied in onderzoek en implementatie van deze materie in de praktijk

Geneesmiddelgebruik, ondervoeding en deficiënties bij ouderen

Over het effect van geneesmiddelgebruik op de voedingsstatus bij ouderen is relatief weinig bekend. Ondanks de hoge prevalentie van ondervoeding en deficiënties in deze kwetsbare leeftijdsgroep, worden de klinische gevolgen van voedingstekorten bij oudere patiënten vaak niet opgemerkt, of gezien als symptomen van ouderdom of comorbiditeit. Daarnaast is in geneesmiddelonderzoek evaluatie van voeding-geneesmiddelinteracties (VGI's) niet verplicht. Vijf verschillende klassen van VGI's worden besproken: het effect van nutriënten, voeding of voedingstoestand op geneesmiddelwerking en het effect van geneesmiddelgebruik op voedingstoestand of deficiënties, met de focus op vitamine D, foliumzuur, magnesium en vitamine B12. Deze systematische benadering van VGI's is een tool voor uitbreiding van dit kennisgebied in onderzoek en implementatie van deze materie in de praktijk

The association between drugs frequently used by the elderly and vitamin D blood levels: a review of observational and experimental studies

The risk of adverse drug reactions (ADRs) rises with increasing age. In the field of ADRs, drug–nutrient interactions (DNIs) are a relatively unexplored area. More knowledge will contribute to the simple prevention of this type of ADR. As the prevalence of vitamin D deficiency in the elderly is high, the primary objective of this review is to evaluate the literature on the relationship between drug use and vitamin D status, focusing on medicines commonly used by the elderly. PubMed was searched for human epidemiological and clinical studies published until early 2013, investigating the relationship between vitamin D blood levels and use of drugs from one of the following groups: proton pump inhibitors (PPIs), biguanides, vitamin K antagonists, platelet aggregation inhibitors, thiazide diuretics, loop diuretics, beta-blocking agents, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II antagonists, statins, benzodiazepines, and antidepressants. A total of 63 publications were identified. Thiazide diuretics, statins, and calcium channel blocking agents were the most frequently studied drug groups. Associations between thiazides and vitamin D were mixed (n = 22), statins had no or positive associations (n = 16) and calcium blockers were not associated or were negatively associated with vitamin D (n = 10). In conclusion, several knowledge gaps exist on the relationship between drug use and vitamin D blood levels. Available data are scarce (particularly for the aged), study characteristics are highly variable, and found associations may be confounded by, amongst other things, the underlying disease. Nonetheless, this review provides a basis for future research on ADRs that contribute to nutrient deficiencies

Drug use is associated with lower plasma magnesium levels in geriatric outpatients; possible clinical relevance

Background: Hypomagnesemia has been associated with diabetes, cardiovascular disease, and other disorders. Drug use has been suggested as one of the risk factors for low magnesium (Mg) levels. In the elderly population, prone to polypharmacy and inadequate Mg intake, hypomagnesemia might be relevant. Therefore, we aimed to investigate associations between drug use and plasma Mg. Methods: Cross-sectional data of 343 Dutch geriatric outpatients were analysed by Cox and linear regression, while adjusting for covariates. Drug groups were coded according to the Anatomical Therapeutic Chemical classification system; use was compared to non-use. Hypomagnesemia was defined as plasma Mg 2; and adrenergic inhalants in male users (PR 3.62; 95%CI 1.73–7.56). Linear regression supported these associations. Conclusion: As polypharmacy and several medications are associated with hypomagnesemia, Mg merits more attention, particularly in diabetes, cardiovascular disease, and in side-effects of proton pump inhibitors and calcium supplements.</p

Drug use is associated with lower plasma magnesium levels in geriatric outpatients; possible clinical relevance

Background: Hypomagnesemia has been associated with diabetes, cardiovascular disease, and other disorders. Drug use has been suggested as one of the risk factors for low magnesium (Mg) levels. In the elderly population, prone to polypharmacy and inadequate Mg intake, hypomagnesemia might be relevant. Therefore, we aimed to investigate associations between drug use and plasma Mg. Methods: Cross-sectional data of 343 Dutch geriatric outpatients were analysed by Cox and linear regression, while adjusting for covariates. Drug groups were coded according to the Anatomical Therapeutic Chemical classification system; use was compared to non-use. Hypomagnesemia was defined as plasma Mg 2; and adrenergic inhalants in male users (PR 3.62; 95%CI 1.73–7.56). Linear regression supported these associations. Conclusion: As polypharmacy and several medications are associated with hypomagnesemia, Mg merits more attention, particularly in diabetes, cardiovascular disease, and in side-effects of proton pump inhibitors and calcium supplements.</p