Safety of benzodiazepines in the geriatric population

Madhusoodanan, Subramoniam; Bogunovic, Olivera

doi:10.1517/14740338.3.5.485

Cited by 175 publications

(114 citation statements)

References 43 publications

(53 reference statements)

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“…Increased sensitivity of this population to the effects of psychotropic medications including benzodiazepines has been reported [26][27][28] . In the Danish National registry database study of 1997-2008 [16] , which included 4,614,807 subjects, 32% (1,480,017) received at least 1 benzodiazepine.…”

Section: Discussionmentioning

confidence: 99%

Hypnotics and Triazolobenzodiazepines - Best Predictors of High-Dose Benzodiazepine Use: Results from the Luxembourg National Health Insurance Registry

Cloos¹,

Bocquet

Rolland-Portal³

et al. 2015

Psychother Psychosom

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Background: Benzodiazepines are not all the same concerning their risk of high-dose use. Methods: We studied benzodiazepine use from the Luxembourg national records of all insured. We calculated the 12-year prevalence from 1995 to 2007. Benzodiazepine users were divided into 3 groups, short-term with no longer than 3-month intake, intermediate with multiple administration with at least a 1-year interruption, and continuous who never stopped. A high-dose user (HDU) was defined as a patient who received a higher dose than the yearly maximum usual therapeutic dose. Results: An average of 16.0% of the adult insured population received at least 1 benzodiazepine annually, 42.9% were older than 50, 55.9% were women, and 5.4% were HDUs. We found that 32.6% were short-term users, 49.0% intermediate and 18.4% continuous. Compared to diazepam, hypnotics had higher risks for high-dose use in at least 1 age group at first-benzodiazepine intake, the risks being greater in elderly subjects and women, the highest risks being with triazolam (adjusted odds ratio = 215.85; 95% confidence interval = 133.75-348.35) in the 69- to 105-year-old group at first-benzodiazepine intake. Anxiolytics had a low risk except for alprazolam and prazepam in the 69- to 105-year-old group at first-benzodiazepine intake, clonazepam and clobazam had the lowest risk in 18- to 43-year-olds at first-benzodiazepine intake. Alprazolam had dispensed volumes increased by threefold over the 12-year period. Conclusion: All hypnotics had higher risks for high-dose use compared to diazepam in continuous users. Two anxiolytics, clonazepam and clobazam, had the lowest risks. Hypnotics and the triazolobenzodiazepines alprazolam and triazolam were most problematic. Elderly subjects and women are at greater risks.

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Section: Discussionmentioning

confidence: 99%

Hypnotics and Triazolobenzodiazepines - Best Predictors of High-Dose Benzodiazepine Use: Results from the Luxembourg National Health Insurance Registry

Cloos¹,

Bocquet

Rolland-Portal³

et al. 2015

Psychother Psychosom

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“…According to the International Narcotics Control Board (INCB), Belgium is one of the leading consumers of benzodiazepines worldwide (19). It is well documented that continued use of benzodiazepines may lead to dependence, and is associated with an increased risk of accidents/falls and cognitive function impairment (20). Therefore, current guidelines advocate a conservative prescription policy, especially with respect to long-term prescription (21).…”

Section: Types Of Drugs Used and Presence Of Ddismentioning

confidence: 99%

Medication management among home-dwelling older patients with chronic diseases: Possible roles for community pharmacists

Mehuys

Dupond

Petrovic

et al. 2012

The Journal of nutrition, health and aging

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Objective: To describe medication management among home-dwelling older adults. These data should allow us to identify potential problems and to indicate target areas for community pharmacist intervention.Design: Cross-sectional observational study Setting: Community pharmacies (n=86) in Belgium.Participants: Home-dwelling older adults using at least one chronic medicine (n=338).Measurements: Data on drug use were taken from the electronic pharmacy databases, while drug adherence was measured by pill count, self-report and estimation by GP and pharmacist. Drug knowledge and practical drug management capacity were assessed by patient interview and questionnaire, respectively. Results:The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample (n=169) used psychotropic medication chronically, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high (98.1%), but 39.6% of individuals was underadherent with at least one medication. Seventy-six % of patients had an acceptable knowledge of the indication for at least 75% of their medication. In nearly 15 % of the study population cognitive impairment was suspected by the Mini-Cog Test. The participants reported several practical problems with drug taking: difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%). Conclusion:This study identified the following aspects of medication management by home-dwelling older adults that could be improved by pharmaceutical care services: (i) assistance of cognitively impaired patients, (ii) management of practical drug taking problems, (iii) DDI screening, (iv) drug adherence, and (v) chronic benzodiazepine use.3

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“…High benzodiazepine utilisation in older adults is especially worrying, since age-related pharmacokinetic-and dynamic alterations may lead to an increased risk of amnesia, confusion, sedation [16,17], hangover effects [18,19] and consecutive risk of falling [20].…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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AIM:(i)To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages.(ii)To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia.(iii)To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. METHODS:Medication charts of 1730 residents from 76 nursing homes in Belgium were collected and analysed, using the ATC classification. Drug name, indication and daily dosage were recorded. From authoritative international sources, we extracted for each drug and each indication a daily dosage recommended not to exceed in older adults, for comparison with observed actual dosages. RESULTS:Among the chronic BZD/Z users (50% of the residents), the leading indication was 'insomnia' (59% of the users) followed by 'anxiety' (17%) and 'unrest' (10%). In the chronic prescriptions of BZD/Zs indicated for insomnia, the actual daily dose exceeded the geriatric upper limit: with lormetazepam in 95% ,zolpidem in 82%, zopiclone in 78% and lorazepam in 35% of the prescriptions. In anxiety, daily doses also exceeded the limit but not to the same extend.Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58 CI95% 1.27-1.97), constipation ) and depression (OR 1.68 CI95% 1.35-2.08). Residents with dementia were less likely of receiving a BZD/Z (OR 0.60 CI95% 0.48-0.74). CONCLUSION:Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed to reduce too high prevalence of chronic use and too high daily dosages in this indication.3

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Safety of benzodiazepines in the geriatric population

Cited by 175 publications

References 43 publications

Hypnotics and Triazolobenzodiazepines - Best Predictors of High-Dose Benzodiazepine Use: Results from the Luxembourg National Health Insurance Registry

Hypnotics and Triazolobenzodiazepines - Best Predictors of High-Dose Benzodiazepine Use: Results from the Luxembourg National Health Insurance Registry

Medication management among home-dwelling older patients with chronic diseases: Possible roles for community pharmacists

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

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