Trends in Anxiolytic-Hypnotic Use and Polypharmacy in Taiwan, 2002–2009: A Nationwide, Population-Based Survey

Wang, Liang‐Jen; Chen, Yi‐Chih; Chen, Chih-Ken; Chou, Wen-Jiun; Chou, Miao-Chun

doi:10.1176/appi.ps.201300066

Cited by 35 publications

(38 citation statements)

References 33 publications

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“…Such definition of polypharmacy may differ from other studies [26, 37], which define it as the combined use of 5 or more drugs daily. Because such anxiolytic-hypnotic polypharmacy is common and has increased in Taiwan [27], more attention should be focused on the potential risk of falls in older people.…”

Section: Discussionmentioning

confidence: 99%

“…According to Wang et al [27], polypharmacy was defined as exposure to two or more BZDs or any BZDs plus Z-drugs within 30 days before the index date. Since the combination of two or more Z-drugs is very rare, we did not analyze such combinations as polypharmacy.…”

Section: Methodsmentioning

confidence: 99%

“…Studies have found that the simultaneous use of two or more anxiolytics or hypnotics (another kind of polypharmacy) is common in Taiwan [27]. However, whether such polypharmacy with BZDs and Z-drugs increases the risk of fall-related injuries requiring hospitalisation in Taiwan remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

Chen

Tsai

et al. 2017

BMC Geriatr

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BackgroundNon-benzodiazepine hypnotics (Z-drugs) are advocated to be safer than benzodiazepines (BZDs). This study comprehensively investigated the association of BZD and Z-drug usage with the risk of hospitalisation for fall-related injuries in older people.MethodsThis study used the Taiwan National Health Insurance Database with a nested matched case-control design. We identified 2238 elderly patients who had been hospitalised for fall-related injuries between 2003 and 2012. They were individually matched (1:4) with a comparison group by age, sex, and index year. Conditional logistic regression was used to determine independent effects of drug characteristics (type of exposure, dosage, half-life, and polypharmacy) on older people.ResultsOlder people hospitalisation for fall-related injuries were significantly associated with current use of BZDs (adjusted odds ratio [AOR] = 1.32, 95% confidential interval [CI] = 1.17–1.50) and Z-drugs (AOR = 1.24, 95%CI = 1.05–1.48). At all dose levels of BZDs, high dose levels of Z-drugs, long-acting BZD, and short-acting BZD use were all significantly increased the risk of fall-related injuries requiring hospitalisation. Polypharmacy, the use of two or more kinds of BZDs, one kind of BZD plus Z-drugs and two or more kinds of BZDs plus Z-drugs, also significantly increased the risk (AOR = 1.61, 95% CI = 1.38–1.89; AOR = 1.65, 95% CI = 1.08–2.50, and AOR = 1.58, 95% CI = 1.21–2.07).ConclusionsDifferent dose levels and half-lives of BZDs, a high dose of Z-drugs, and polypharmacy with BZDs and Z-drugs were associated with an increased risk of fall-related injury requiring hospitalisation in older people. Physicians should balance the risks and benefits when prescribing these drug regimens to older people considering the risk of falls.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

Chen

Tsai

et al. 2017

BMC Geriatr

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“…The sex and age distributions of patients in the LHID2000 do not differ significantly from those of the general population. 27,28 …”

Section: Data Sourcementioning

confidence: 99%

Risk of Mortality Among Patients Treated With Antipsychotic Medications

Wang

Lee

Yuan

et al. 2016

Journal of Clinical Psychopharmacology

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In this nationwide population-based study, we examined whether haloperidol exposure is associated with a higher risk of mortality than are other antipsychotic medications. Patients who newly received monotherapy with chlorpromazine (n = 2133), haloperidol (n = 4454), quetiapine (n = 1513), and risperidone (n = 1046) between January 1, 2001, and December 31, 2011, were selected from a random sample of the 1 million enrollees of the Taiwan National Health Insurance Research Database. The association between antipsychotic prescription and mortality was estimated through Cox proportional hazard regression. To examine the mortality rates of antipsychotics at different exposure durations, we compared the differences among short-term (≤30 days), midterm (31-90 days), and long-term (>90 days) antipsychotic use. The mortality rates during the follow-up among the chlorpromazine, haloperidol, quetiapine, and risperidone groups were 17.4%, 45.5%, 26.8%, and 25.9%, respectively. The mortality risk among patients receiving haloperidol was the highest within 30 days of the prescription, after which the risk reduced rapidly. Compared with the patients receiving chlorpromazine, the mortality risk was higher in short-term (adjusted hazard ratio, 2.11; 95% confidence interval, 1.87-2.39) and midterm haloperidol users (1.86; 1.54-2.25) than in long-term users (0.99; 0.61-1.61). In conclusion, haloperidol use is associated with higher mortality risk than other antipsychotic medications. The mortality risk varies according to the duration of drug exposure. Underlying characteristics and medical conditions may influence the estimation of the mortality risk. Clinicians should pay attention to the mortality risk when prescribing antipsychotic medications, particularly for the elderly and critically ill patients.

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“…Furthermore, the greatest increases in use between 2002 and 2009 were seen for the drugs clonazepam and zolpidem, which, in our study, were the two most commonly prescribed medications for the psychiatric outpatient population. The annual prevalence of zolpidem use in Taiwan increased from 2.4% in 2002 to 4.2% in 2009 [25]. The relatively higher prevalence of hypnotic use in this study might be explained by the fact that most psychiatric outpatients had psychiatric disorders, including neurotic disorders and affective disorders.…”

Section: Discussionmentioning

confidence: 79%

Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey

Dai

Chen

et al. 2016

IJERPH

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(1) Background: Limited studies have utilized nationwide data to assess the patterns of psychiatric practice in other countries. In this study, data from the National Health Insurance Research Database in Taiwan (NHIRD-TW) for 2012 was analyzed to determine the patterns of psychiatric outpatient practice in Taiwan; (2) Methods: To determine the patterns of psychiatric outpatient practice in Taiwan, the data were drawn from the datasets of Taiwan’s National Health Insurance Research Database for 2012, with 619,760 records of outpatient visits representing 1/500 of all the claims in Taiwan for that year. The analysis of psychiatric outpatient visits included patient demographics, diagnoses, and prescribed medications; (3) Results: Neurotic disorders were the most prevalent diagnoses (43.1%, n = 5714). Hypnotics-sedatives and anxiolytics were prescribed in 51.7% (n = 6850) and 39.1% (n = 5181) of psychiatric visits, respectively, with zolpidem being the most commonly prescribed drug (22.6%, n = 2998); and (4) Conclusion: Hypnotics and sedatives were widely prescribed for the outpatient population, and zolpidem had the highest annual prevalence of use. These findings deserve the attention of clinicians and policy makers for monitoring the abuse and dependence of these agents and subsequent adverse events.

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Trends in Anxiolytic-Hypnotic Use and Polypharmacy in Taiwan, 2002–2009: A Nationwide, Population-Based Survey

Cited by 35 publications

References 33 publications

Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan

Risk of Mortality Among Patients Treated With Antipsychotic Medications

Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey

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