Polypharmacy and the risk of adverse drug reactions in older women: a systematic review
DOI:
https://doi.org/10.55892/jrg.v9i20.3397Keywords:
Polypharmacy, Adverse drug reactions, Older women, Pharmacovigilance, Patient safetyAbstract
Objective: To analyze the impact of polypharmacy on the risk of adverse drug reactions (ADRs) in older women through a systematic literature review. Methods: A systematic search was conducted in the PubMed (MEDLINE), LILACS (BIREME), and Embase (Elsevier) databases, including studies published between March 2016 and March 2026. MeSH and DeCS descriptors related to “Polypharmacy,” “Adverse Drug Reactions,” “Aged,” “Women,” and “Female” were used and combined using the Boolean operators AND and OR. Observational studies involving older women or geriatric populations with sex-stratified analyses, aged ≥60 years, undergoing polypharmacy (≥5 medications), and evaluating outcomes related to adverse drug reactions were included. Articles published in English, Portuguese, and Spanish were considered. Study selection followed the PRISMA recommendations. Results: Of the 822 articles identified, 12 met the eligibility criteria. Clinical frailty, multimorbidity, psychotropic drug use, the presence of potentially inappropriate medications, and the concomitant use of five or more medications were among the main factors associated with an increased risk of ADRs in older women. The most frequently reported adverse events included delirium, falls, dizziness, gastrointestinal bleeding, renal and hepatic disorders, cognitive decline, drug-related hospitalizations, and mortality. Prospective and retrospective observational studies conducted in hospital settings, geriatric units, and national pharmacovigilance databases predominated, with methodological quality considered satisfactory. Conclusion: Polypharmacy was associated with an increased occurrence of adverse drug reactions in older women, particularly in the presence of frailty and multimorbidity. The findings reinforce the importance of pharmacotherapeutic monitoring, periodic prescription review, and rational deprescribing strategies to promote medication safety in this population.
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