Health Care Systems, Pharmacology / 28.04.2026

medication management is getting harder Patient needs are getting more complex and that's starting to show in how medications are prescribed and managed. Patients are living longer, often with more than one condition at the same time and treatment plans now involve several drugs rather than just one or two. That makes medication decisions harder to manage in practice, especially when different conditions are being treated at once. It also explains why more advanced pharmacy training, such as obtaining a doctor of pharmacy degree, is becoming relevant across different healthcare settings. More patients are on multiple medications at the same time. Recent data suggests that around with that number rising in older age groups. Among adults over 60, roughly one in three are taking five or more medications on a regular basis. This affects how treatment is handled day to day. Each additional drug increases the chance of interactions, side effects and changes in how other medications behave in the body. It also makes monitoring harder, particularly when care is spread across different providers. A patient might receive prescriptions from a general practitioner, a specialist and a hospital team and those decisions don't always sit in one place. Adherence is another issue. Dosing schedules don't always align and some medications have specific requirements around food or timing. It doesn't take much for something to go wrong. Missing doses, taking drugs too close together, or misunderstanding instructions can all affect how well a treatment works. In some cases, patients end up stopping medication altogether because the routine becomes too difficult to manage.
Addiction, Mental Health Research / 06.08.2024

[caption id="attachment_62745" align="alignleft" width="130"] Luke Cavanah[/caption] Luke Cavanah, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, PA 18509     MedicalResearch.com: What is the background for this study? Response:  “Selective” serotonin reuptake inhibitors (SSRI) are a class of medications that are first-line treatments for many anxiety, depressive, and other psychiatric disorders.1–3 Despite their name, SSRIs often have activity on other receptors and chemicals.4 One such SSRI that is known for being particularly nonselective is paroxetine.5 Paroxetine’s mechanisms of action are summarized in the figure below which shows binding not only to the serotonin transporter (SERT) but also to the norepinephrine transporter (NET), nitric oxide synthetase (NOS), the muscarinic (M1) receptor, and the liver cytochrome 2D6 enzyme. Paroxetine’s receptor promiscuity, especially its anticholinergic activity, can contribute to unfavorable adverse effects.5 Older adults (65+) are particularly vulnerable to some of these adverse effects. The American Geriatrics Society (AGS) regularly publishes an explicit list, called the Beer’s List, of what they call “potentially inappropriate medications (PIMs)”, which are medications they recommend avoiding in this demographic when having certain disorders/conditions or most clinical contexts. The AGS Beers Criteria, in 2012, 2019, and most recently in 2023, has identified paroxetine as a PIM due to its strong anticholinergic activity and high risk of sedation and orthostatic hypotension, and thus they recommend it should be avoided in this population in most circumstances.6–8 Given the recommendation against the use of paroxetine in older adults, we were interested in examining the utilization of paroxetine by U.S. Medicare beneficiaries. Medicare patients primarily consist of people 65+ and cover 94% of non-institutionalized people in this age group.9