The 10 Most Frequently Observed PIMs
| PIM Description | Percentage of Total PIMs (N = 56,605)a | |
|---|---|---|
| 1. | Stop benzodiazepines (sedative, may cause reduced sensorium, impair balance) | 15.7 |
| 2. | Stop benzodiazepines taken for ≥4 weeks (no indication for longer treatment; risk of prolonged sedation, confusion, impaired balance, falls, road traffic accidents; all benzodiazepines should be withdrawn gradually if taken for >4 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly) | 11.9 |
| 3. | Stop drugs likely to cause constipation (eg, antimuscarinic/anticholinergic drugs, oral iron, opioids, verapamil, aluminum antacids) in patients with chronic constipation where nonconstipating alternatives are available (risk of exacerbation of constipation) | 5.1 |
| 4. | Aspirin, clopidogrel, dipyridamole, vitamin K antagonists, direct thrombin inhibitors, or factor Xa inhibitors with concurrent substantial bleeding risk, that is, uncontrolled severe hypertension, bleeding diathesis, recent nontrivial spontaneous bleeding (high risk of bleeding) | 4.6 |
| 5. | Stop PPI for uncomplicated peptic ulcer disease or erosive peptic esophagitis at full therapeutic dosage for >8 weeks (dose reduction or earlier discontinuation indicated) | 4.5 |
| 6. | Stop colchicine if eGFR <10 mL/min/1.73m2 (risk of colchicine toxicity) | 4.0 |
| 7. | Stop NSAIDs if eGFR <50 mL/min/1.73m2 (risk of deterioration in renal function) | 3.6 |
| 8. | Stop use of oral or transdermal strong opioids (morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed) | 3.5 |
| 9. | Stop neuroleptic drugs (may cause gait dyspraxia, parkinsonism) | 3.2 |
| 10. | Stop hypnotic Z-drugs such as zopiclone, zolpidem, zaleplon (may cause protracted daytime sedation, ataxia) | 3.2 |
eGFR = estimated glomerular filtration rate; NSAID = nonsteroidal anti-inflammatory drug; PIM = potentially inappropriate medication; PPI = proton pump inhibitor; WHO = World Health Organization.
Note: PIMs provide information on correct deprescribing according to the Screening Tool of Older Person’s Prescriptions (STOPP) criteria.
↵a Unique PIMs per patient over 6 years.