Characterizing treatment initiation with central nervous system–active polypharmacy among adults with dementia
Donovan T. Maust, Rachel C. Davis, Julie Strominger, Steven C. Marcus, Hyungjin Myra Kim, Tanner Caverly, Frederic C. Blow, Lauren P. Wallner, Sarah Krein, Sarah E. VordenbergAbstract
INTRODUCTION
Central nervous system (CNS) –active polypharmacy, defined as concurrent use of antidepressants, antipsychotics, anti‐seizure medications, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, opioids, or skeletal muscle relaxants for ≥ 31 consecutive days, poses significant risks patients with dementia.
METHODS
Among community‐dwelling patients in Medicare plans aged ≥ 65 with dementia and Medicare Part D coverage in 2021, we determined the rate of CNS‐active polypharmacy initiation as well as medication and prescribing clinician characteristics.
RESULTS
Among beneficiaries with dementia ( n = 1,214,928, mean age 81.6 years), 7.8% ( n = 94,190) experienced incident polypharmacy. Antidepressants were the most frequent class (92.3%), and quetiapine (30.9%), gabapentin (29.0%), and trazodone (28.3%) the top individual medications. At the time of initiation, 43.8% of patients were prescribed all CNS‐active medications by a single clinician; primary care clinicians accounted for most polypharmacy prescriptions.
DISCUSSION
Interventions to address polypharmacy should focus on development of guidelines targeting individual prescribers to help clarify appropriate use of CNS‐active medications.