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Table 1 Important aspects to consider when performing a medication review

From: Drug-related problems and medication reviews among old people with dementia

Impaired body function: renal function, liver function, contraindications, allergies, swallowing problems
Certain drugs that need special attention: toxic drugs, drugs prone to producing side effects, potentially inappropriate drugs
Interactions: drug-drug, drug-food interactions, interactions between drugs and herbal medicinal products
The patient’s clinical symptoms in relation to drug treatment: symptoms (adverse drug reactions)
Overall view of the patients’ medication: proper drug selection, dosage, duration of treatment, polypharmacy, indication for therapy, untreated indication, compliance, OTC drugs, effectiveness, cost-effectiveness and general judgment of the patient’s drug use
Medication reconciliation: by conducting medication reconciliation, the pharmacists ensure that the medication administration records used at the wards are updated, accurate, and complete. Various information sources should be used, including drug lists from primary care centers, the patients’ hospital medical records, and when possible, interviews with patients and/or relatives.
  1. Abbreviations: OTC over-the-counter