Fall accidents, in which psychotropic polypharmacy is sometimes involved, are serious in medical safety management. We, clinical pharmacists, started to participate in the multi-disciplinary care team for inpatients at the psychiatric unit in Kyoto University Hospital in April 2012. After the patient interview on admission day, we propose a suitable prescription for the proper use of psychotropic drugs. In this study, we investigated the impacts of clinical pharmacy interventions aiming to reduce the psychotropic polypharmacy by evaluating fall accidents during hospitalization. We calculated the dosages of hypnotics, anxiolytics, antipsychotics, antidepressants and antiparkinson agents prescribed at the psychiatry unit in Kyoto University Hospital, as corresponding values, which were diazepam, chlorpromazine, imipramine and biperiden equivalents, respectively, from the computerized electronic records for the period 2011 -2014. We found a significant reduction in the dosages of long and short-acting hypnotics, anxiolytics, typical antipsychotics (but not atypical antipsychotics) and antiparkinsonian drugs after the introduction of the pharmacist intervention. In contrast, there was a trend toward increased dosages of antidepressants. The numbers of concomitant drugs of each of hypnotics and antipsychotics were decreased significantly. Furthermore, the number of fall accidents reported in the incident reports was decreased to 43-45 from 55 accidents/year after the intervention. These results suggest that clinical pharmacist intervention could contribute to the reduction of the doses used and prevention of polypharmacy in psychotropic drug use, and might be associated with the decrease in the number of fall accidents.

ObjectivesWe investigated the utility of switching from benzodiazepines to suvorexant or eszopiclone to manage benzodiazepine-unresponsive insomnia in patients with major depressive disorder (MDD) in a randomized, open-label study.MethodsPatients with MDD who have insomnia symptoms (a score of >7 on the Insomnia Severity Index Japanese version [ISI-J]), who had received benzodiazepine treatment for more than 2 weeks (n = 18) were randomized to 4 weeks of suvorexant (20 or 15 mg/d) or eszopiclone (3 or 2 mg/d) treatment. The primary endpoint was an improvement in insomnia severity from baseline assessed by the ISI-J score at 2 and 4 weeks after switching from benzodiazepines. The secondary endpoints included changes in the scores of the Pittsburgh Sleep Quality Index Japanese version, the Beck Depression Inventory II, Generalized Anxiety Disorder 7, the digit span test, and the digit symbol substitution test from baseline. Adverse events were recorded throughout the study.ResultsPatients taking suvorexant or eszopiclone had improved ISI-J scores (−4.3 for suvorexant and −4.1 for eszopiclone at week 4; P = 0.04 for eszopiclone). Both drugs tended to improve the Beck Depression Inventory II and Generalized Anxiety Disorder 7 scores 2 and 4 weeks after switching. The Pittsburgh Sleep Quality Index Japanese version, digit symbol substitution test, and digit span test scores and the incidence of adverse events did not change from baseline.ConclusionsSwitching to suvorexant or eszopiclone was well tolerated and improved the severity of benzodiazepine-unresponsive insomnia in MDD patients. Both drugs could be beneficial alternatives to benzodiazepines for treating insomnia in MDD patients.