This pilot study set out to examine, for the first time in Bulgaria, how effectively the EU(7)-PIM List can identify potentially inappropriate medications (PIMs) prescribed to older adults. Drug-related complications are well-documented contributors to increased rates of illness, death, and healthcare use. Although earlier Bulgarian research has discussed methods for detecting such medications, the application of the EU(7)-PIM List has not been thoroughly explored and requires further evaluation. A prospective prescription assessment was undertaken for patients aged 65 years and older in a community pharmacy located in Veliko Turnovo, Bulgaria. The investigation, conducted between November 2022 and April 2023, reviewed prescriptions reimbursed by the National Health and Insurance Fund. Data, anonymized by the pharmacy manager, included patients’ ages, prescribed drugs, and corresponding ICD codes. Data from 255 patients, covering 2,623 prescribed medicines, were analyzed. Polypharmacy—defined as the daily use of more than five medications—was recorded in 61.96% of participants, of whom 67% were prescribed at least one PIM according to the EU(7)-PIM List. Overall, 173 PIMs were found, distributed across four main therapeutic categories: alimentary tract and metabolism, blood and hematopoietic system, cardiovascular system (CVS), and nervous system. Most PIMs (75.72%) belonged to the CVS class. Within this group, digoxin and several antiarrhythmics (propafenone, flecainide, amiodarone) were each responsible for 11 PIMs. Trimetazidine accounted for nine cases, centrally acting antiadrenergic drugs for 22 (mostly moxonidine, n=16), and peripherally acting agents like doxazosin for another 22. Diuretics, especially spironolactone, were implicated in 24 PIMs, while calcium channel blockers such as verapamil accounted for 18. Antithrombotic agents represented the largest share (n=30), including acenocoumarol, dabigatran, rivaroxaban, and apixaban. Analysis of ICD data indicated that most PIMs were linked to cardiovascular diagnoses, particularly ICD I11.0 and I11.9, which corresponded to 40 and 47 PIMs, respectively. The study underscores the widespread presence of potentially inappropriate prescribing, especially among older patients with cardiovascular diseases. The results support the EU(7)-PIM List as an effective reference for identifying high-risk medications in the elderly. Considering the growing prevalence of polypharmacy and the ageing population, it is essential that healthcare professionals, policymakers, and educators adopt stronger measures to monitor, regulate, and reduce PIM use as part of comprehensive deprescribing strategies in geriatric care.
