Half-life Benzodiazepines Research Articles

Deprescribing in Older Poly-Treated Patients Affected with Dementia.

Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.

Benzodiazepines prescribing in eldery patients: A study about the prescribing behaviour of tunisian psychiatrists

IntroductionPrescribing benzodiazepines (BZD) in patients over 65 years old requires special precautions in view of the frequency and the severity of their side effects, especially in this age group.ObjectivesThe objectives of our work were to evaluate the modalities of BZDs prescribing in elderly patients in psychiatry and to assess their compliance with international recommendations.MethodsThis is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.ResultsOne hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. Special precautions were taken in elderly patients by 96.5% of the participants. In eldery patients, long half-life BZDs were prescribed in 15% of cases. The majority of the participants indicated that the risk of falls (98.1%) and memory impairments (75.2%) were the main risks to which they were particularly vigilant during the prescribing of BZDs in eldery patients. In the elderly, 20% of the participants said they did not take special precautions when stopping BZDs.ConclusionsThe frequency and severity of side effects associated with BZDs in the elderly are the cause of strict prescribing rules in this age group. According to the results of our study and to the literature data, the prescribing practices of these molecules in the elderly remain insufficiently in accordance with the guidelines.

Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015

BackgroundThe high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015.MethodsAn analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated.ResultsOver the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%).ConclusionThe dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.

Benzodiazepine exposure in subjects with incident Alzheimer's disease and related syndromes in France: a longitudinal study 2011-2017.

Benzodiazepines are commonly used for behavioral and psychiatric symptoms of dementia, despite their numerous adverse effects and the lack of evidence regarding their efficacy in this context. We studied longitudinal benzodiazepines exposure in incident cases of Alzheimer's disease and related syndromes (ADRS) in France. We used a cohort of incident ADRS patients identified in 2012 within the national health data system. Benzodiazepines exposure was measured 1 year before, to 5 years after ADRS identification. Quarterly benzodiazepines prevalence and incidence were computed. We identified factors associated with long half-life benzodiazepines initiation. A total of 106 508 subjects were included. Quarterly benzodiazepines prevalence was stable (around 25%) but we saw an important decrease in long half-life benzodiazepines compensated by an increase in short half-life benzodiazepines. In most benzodiazepine initiations, the first episode lasted less than 3 months. Factors associated with initiating a long half-life benzodiazepine were young age, male gender, no registration with ADRS as a long-term disease, having consulted an ADRS specialist, antipsychotic reimbursement before the index date, no admission in nursing home. Prevalence of benzodiazepines use remains high in subjects with ADRS despite guidelines for their avoidance. However, indicators regarding benzodiazepine initiations (duration, benzodiazepine type) suggest some caution in their use.

Benzodiazepine Dispensing to Persons With Dementia in France, 2011-2016: A Nationwide Study

ObjectiveTo study temporal trends of benzodiazepine exposure among incident Alzheimer's disease and related dementia (ADRD) cohorts between 2011 and 2016. DesignRepeated cross-sectional study. Setting and ParticipantsThree nationwide incident ADRD cohorts (community-dwelling and institutionalized subjects) were identified in 2011, 2013, and 2016 through the French health insurance database. Subjects were followed 4 semesters around ADRD identification [Semester −2 (S−2) to Semester 2 (S2)]. MeasuresOdds ratios (ORs) for semestrial prevalent exposure, initiation, and adherence to benzodiazepine prescription recommendations (prescription duration <3 months, single reimbursement) were computed using multivariate logistic regressions for each cohort and according to benzodiazepine half-life. ResultsAmong 262,024 community-dwelling subjects, as compared to 2011, overall benzodiazepine prevalence risk decreased slightly immediately after ADRD identification [S1: aOR2013 = 0.93 (0.91-0.95), aOR2016 = 0.95 (0.93-0.97)] and did not differ during S2. Among 72,013 institutionalized subjects, it increased over time [S2: aOR2013 = 1.16 (1.11-1.21), aOR2016 = 1.26 (1.21-1.32)]. Long half-life benzodiazepine prevalence risk decreased in the 4 semesters among recent cohorts, for both populations [S2: community-dwelling: aOR2013 = 0.77 (0.74-0.79), aOR2016 = 0.61 (0.59-0.64); institutionalized: aOR2013 = 0.74 (0.68-0.80), aOR2016 = 0.58 (0.54-0.63)]. Short half-life benzodiazepine prevalence risk increased [S2: community-dwelling: aOR2013 = 1.13 (1.10-1.16), aOR2016 = 1.22 (1.20-1.25); institutionalized: aOR2013 = 1.26 (1.21-1.32), aOR2016 = 1.44 (1.38-1.50)]. The same patterns were observed for benzodiazepine initiation. Adherence to benzodiazepine prescription recommendations (based on French prescription duration) worsened over years [prescription duration <3 months: aOR2013 = 0.90 (0.86-0.95), aOR2016 = 0.90 (0.85-0.95), single reimbursement: aOR2013 = 0.95 (0.91-1.00), aOR2016 = 0.94 (0.90-0.99)]. Conclusions and ImplicationsLong half-life benzodiazepine exposure was reduced whereas short half-life benzodiazepine exposure increased, and adherence to recommendations worsened (prescription duration longer than 3 months and more than a single reimbursement in recent cohorts). Efforts from prescribers and authorities are required in order to restrict psychotropic exposure among the ADRD population. Further research among institutionalized ADRD subjects could provide useful data to disentangle the effects of changes in prescribing practices and in patients' characteristics.

Long-term users of benzodiazepines in Colombia: Patterns of use and cessation of treatment

BackgroundBenzodiazepines have low abuse potential, but patients often develop physical dependence and neurological impairments. The objective of this study was to investigate treatment cessation and use of high doses in long-term benzodiazepine users in Colombia. MethodsRetrospective study. Patients who used benzodiazepines for at least six months (long-term) were selected from a prescription database and followed from initiation of benzodiazepine treatment for up to 30 months. We investigated treatment duration and compared patients who received normal and high (≥2 mean prescribed daily dose) doses. ResultsOnly 1255 (6.1 %) out of 20,567 patientsprescribed benzodiazepines became long-term users; their mean age was 60.6 years (SD=20.0) and 61.7 % were women. Mean high doses were used by 42.5 % (n=534) of the sample. Age under 20 years was a protector, whereas the long half-life benzodiazepines and use of other neurological medications were predictors of high dosage. Overall, 44.8 % (n=563) of the sample was still using benzodiazepines at the end of the study period. The use of antidepressants, antipsychotics, and anticonvulsants were negatively associated with cessation of benzodiazepine treatment. ConclusionsA low proportion of patients starting benzodiazepines became long-term users. Nearly half of them used high doses and continued the medication for up to 30 months. Use of concomitant neurological drugs was associated with higher doses and less cessation.

Risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in chronic insomnia: A study on 1272 individuals referred for polysomnography

Given conflicting data in the literature, the aim of this study was to examine the risk of hypertension associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of insomnia sufferers. Demographic and polysomnographic data from 1272 insomnia sufferers recruited from the research database of the sleep laboratory were analyzed. Hypertension status was defined by the presence of one of the following: self-report at interview of either a physician's diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥ 140 mm Hg or an average diastolic blood pressure ≥ 90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in insomnia sufferers. The prevalence of hypertension in insomnia sufferers is 30.03%. After adjustment for major confounding factors associated with hypertension, multivariate logistic regression analysis revealed that short sleep duration (< 5 hours) [OR 1.91 (95% CI 1.15–3.16)], severely reduced sleep efficiency (< 65%) [OR 1.57 (95% CI 1.01–2.45)], high sleep fragmentation (sleep fragmentation index ≥ 18/hour) [OR 1.59 (95% CI 1.10–2.30)], and long-term use of short [OR 1.78 (95% CI 1.03–3.09)] or intermediate [OR 2.10 (95% CI 1.12–3.92)] half-life benzodiazepine receptor agonists were significant risk factors of hypertension in insomnia sufferers. In insomnia sufferers, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of hypertension. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and hypertension.

The "CHROME criteria": Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.

Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria. Observational prospective longitudinal study. Single nursing home in Las Palmas de Gran Canaria, Spain. 288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia. Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription. Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107). For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians' diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005). Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

Approach to the risk of delirium in an orthogeriatric unit

IntroductionThe objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. Material and methodsProspective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. ResultsEighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71–105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (p=0.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group was 3.8 days (p=0.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs. 17% p=0.036). ConclusionsExperimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.

Benzodiazepines and frail elderly people: how prescribing can be optimized?

In France, benzodiazepine (BZD) is frequently prescribed in elderly people (EP). Long-term efficacy is often questioned, and treatment has to be regularly re-examined, especially in EP. In our Geriatric day-hospital for assessment of frailty, a multidisciplinary team evaluates the patients and gives them preventative measures against the loss of autonomy. Medication evaluation is part of these measures. The aim of our study was to evaluate the impact of a standardized intervention on the optimization of BZD treatment. Setting and method: After a short interview and the delivery of an information booklet about BZD, patients were proposed an optimization of their BZD treatment (dosage reduction, occasional medication, switch to a short half-life BZD, or total discontinuation). Patients were followed up monthly by a phone-interview over a 6-months period. The main outcome measure was the prevalence of BZD optimized treatments after a 6 months follow-up. Results: 18 patients were included. Among them, 50% have been taking a BZD for more than 10 years, and 39% were prescribed a long half-life BZD, which can be qualified as inappropriate in EP. 50% of the subjects were frail and 44% pre-frail, according to the Fried criteria. At the end of the study, 33% of the patients had their BZD treatments optimized, including 17% of total discontinuation. Conclusion: In the frail elderly population, a standardized intervention can be useful to improve BZD treatment. An extension to this intervention would be the creation of an organization tasked with routinely monitoring the patients' withdrawal over a six month period.

Objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are risk factors for high blood pressure in individuals with insomnia: a study in 1272 individuals referred for sleep examinations

IntroductionGiven conflicting data in the literature, the aim of this study was to examine the risk of high blood pressure (HBP) associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of individuals with insomnia. MethodsDemographic and polysomnographic data from 1272 individuals with insomnia recruited from the research database of the sleep laboratory of Erasme Hospital were analyzed. HBP status was defined by the presence of one of the following: self-report at interview of either a physician's diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of HBP associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in individuals with insomnia. ResultsThe prevalence of HBP in individuals with insomnia is 30.03%. After adjustment for major confounding factors associated with HBP, multivariate logistic regression analysis revealed that short sleep duration (<5 h), severely reduced sleep efficiency (<65%), high sleep fragmentation (sleep fragmentation index ≥18/h), and long-term use of short or intermediate half-life benzodiazepine receptor agonists were significant risk factors for HBP in individuals with insomnia. ConclusionIn individuals with insomnia, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of HBP. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and HBP.

Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography

Background: To date, few studies have investigated the prevalence and risk factors of excessive daytime sleepiness (EDS) in major depression. Thus, the aim of the present study was to examine the prevalence and risk factors of EDS in a large sample of individuals with major depression.Methods: Data from 703 individuals with major depression were retrospectively collected from the sleep laboratory research database of Erasme Hospital for analysis. A score of > 10 on the Epworth Sleepiness Scale was used as the cut-off for EDS. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of EDS in major depression.Results: The prevalence of EDS in our sample was 50.8%. Multivariate logistic regression analysis revealed that the following were significant risk factors of EDS in major depression: non-use of short to intermediate half-life benzodiazepine receptor agonists, BMI ≥ 25 kg/m², age < 60 years, C-reactive protein > 7 mg/L, Beck Depression Inventory score ≥ 16, atypical depression, apnea-hypopnea index ≥ 15/h, and use of selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors.Limitations: To evaluate EDS, we used the Epworth Sleepiness Scale, which only allows for a subjective measure of daytime sleepiness.Conclusion: EDS is a common symptom in individuals with major depression. In this subpopulation, interventions are possible for most risk factors of EDS, which justifies improved management of this symptom to avoid its negative consequences.

Abordaje del riesgo de delirium en una unidad de ortogeriatría

IntroductionThe objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. Material and methodsProspective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. ResultsEighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). ConclusionsExperimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.

Application of the STOPP criteria in hospitalised elderly patients to detect and optimise inappropriate psychopharmaceutical prescriptions.

Psychotropic drugs are frequently used in the elderly population, but their inappropriate prescription can cause numerous adverse effects and interactions. To evaluate the impact of a multidisciplinary intervention to detect and optimise inappropriate prescriptions of psychotropic drugs in patients aged over 75years in a hospital setting. A prospective study which included every patient aged over 75years admitted to the Consorcio Hospital General in Valencia, Spain,and who had been prescribed psychotropic drugs inappropriately, carried out over 1 year. The intervention was to detect inappropriate prescriptions of psychotropic drugs using the STOPP criteria, treatment optimisation by a team of psychiatrists, readjustment of the electronic prescription register, and communication to the primary care physician. The impact of the intervention was assessed by measuring the persistence of the changes made 3 months after discharge and by quarterly assessment of inappropriate prescriptions. Of 4571 admissions, 378 inappropriate prescriptions were detected in 346 patients. The drugs most frequently used were long half-life benzodiazepines (70%), which were substituted in 62% of the cases, withdrawn in 32%, and maintained in 6%. At 3 months follow-up, the changes had been maintained by the patients' primary care physician in 67%. Evaluation of the prescriptions during the subsequent quarters of the year showed a significant decrease in the inappropriate prescriptions, especially benzodiazepines. Coordinated intervention by pharmacologists and psychiatrists in hospital settings, and communication between these professionals and primary care teams, can reduce psychotropic drugs inappropriately prescribed to the elderly.

PHP57 - Long-Term Users of Benzodiazepines in Colombia: Patterns of use and Cessation of Treatment

Abstract Background Benzodiazepines have low abuse potential, but patients often develop physical dependence and neurological impairments. The objective of this study was to investigate treatment cessation and use of high doses in long-term benzodiazepine users in Colombia. Methods Retrospective study. Patients who used benzodiazepines for at least six months (long-term) were selected from a prescription database and followed from initiation of benzodiazepine treatment for up to 30 months. We investigated treatment duration and compared patients who received normal and high (≥2 mean prescribed daily dose) doses. Results Only 1255 (6.1 %) out of 20,567 patientsprescribed benzodiazepines became long-term users; their mean age was 60.6 years (SD=20.0) and 61.7 % were women. Mean high doses were used by 42.5 % (n=534) of the sample. Age under 20 years was a protector, whereas the long half-life benzodiazepines and use of other neurological medications were predictors of high dosage. Overall, 44.8 % (n=563) of the sample was still using benzodiazepines at the end of the study period. The use of antidepressants, antipsychotics, and anticonvulsants were negatively associated with cessation of benzodiazepine treatment. Conclusions A low proportion of patients starting benzodiazepines became long-term users. Nearly half of them used high doses and continued the medication for up to 30 months. Use of concomitant neurological drugs was associated with higher doses and less cessation.

Number of illness episodes as predictor of residual symptoms in major depressive disorder

Notwithstanding major depressive disorder (MDD) is a recurring and chronic condition, relatively few variables have consistently been shown to predict its course. Residual depressive symptoms may be associated with disability and functional impairment but few studies evaluated clinical correlates associated with these symptoms and their impact on functioning after adjustment for potential confounders. Therefore, our study aimed to investigate factors associated with residual depressive symptoms and their impact on the course of MDD. The sample consisted of 210 consecutive MDD euthymic outpatients (67.6% females; mean age = 52.1 ± 15.5), admitted to the Section of Psychiatry, University of Genoa (Italy). Residuals depressive symptoms were significantly associated with female gender; use of short half-life benzodiazepines; longer duration of the current depressive episode; higher number of illness episodes; and higher duration of illness. Conversely, prior treatment with first-generation antipsychotics, later age of illness onset and first hospitalization were less frequently observed among patients with residual symptoms. After multivariate analyses, only duration of current illness episodes (ß = 0.003; p = <0.005) and substance abuse (ß = 0.042; p = <0.05) remained significantly associated with residual symptoms. Our findings indicate that residual depressive symptoms conferred a pernicious illness course in this specific cohort of MDD patients. Future trials mainly targeting these burdensome symptoms are warranted.

Association Between Psychotropic and Cardiovascular Iatrogenic Alerts and Risk of Hospitalizations in Elderly People Treated for Dementia: A Self-Controlled Case Series Study Based on the Matching of 2 French Health Insurance Databases

BackgroundElderly people are at risk of repeated hospitalizations, some of which may be drug related and preventable. In 2011, a group of French healthcare experts selected 5 iatrogenic alerts (IAs), based on criteria identified in a literature search and from their professional experience, to assess the appropriateness of medication in elderly patients. ObjectivesOur objective was to examine the association between hospitalizations and IAs in elderly patients treated for Alzheimer disease who are particularly sensitive to adverse drug events. DesignA 2-year (January 1, 2011, to December 31, 2012) longitudinal national database study, with a study design similar to self-controlled case series, was performed to analyze data on drug prescriptions and hospitalization. IAs were defined as (1) long half-life benzodiazepine; (2) antipsychotic drugs in patients with Alzheimer disease; (3) co-prescription of 3 or more psychotropic drugs; (4) co-prescription of 2 or more diuretics; and (5) co-prescription of 4 or more antihypertensive drugs. Data were obtained by matching of 2 French National Health Insurance Databases. SettingFrance. ParticipantsAll affiliates, aged ≥75 years, receiving treatment for Alzheimer disease, alive on January 1, 2011 were included. MeasurementsWe calculated the relative increase in the number of hospitalizations in patients with IAs. The analysis was performed over four 6-month periods. ResultsA total of 10,754 patients were included. During the periods with IAs, hospitalization rates increased by 0.36/year compared with 0.23/year in the periods without for the same patient, and the number of hospitalizations doubled [proportional fold change = 1.9, 95% confidence interval (1.8, 2.1)]. We estimated that 22% [95% confidence interval (20%, 23%)] of all hospitalizations were associated with IAs, 80% of which were due to psychotropic IAs. ConclusionsThe IAs could be used as a simple and clinically relevant tool by prescribing physicians to assess the appropriateness of the prescription in elderly patients treated for Alzheimer disease.

Benzodiazepine use in elderly population in Latin America

Growing information has emphasized the risk of benzodiazepines (BZD), particularly among the elderly. However, the information available in Latin America is scarce. to review the available information on the use of BZD in older adults in Latin America to achieve an overview of the information currently available, and a thorough understanding of this phenomenon in our region. A systematic review with MeSH terms “elderly”, “latinamerican” and “benzodiazepines” was performed in PubMed and with each Latin American country. A search in databases SciELO and LILACS was also performed. In all, 126 items of finally selected 21 that met the inclusion criteria. Studies show that consumption of benzodiazepines in the elderly population in Latin America is high, with a preponderance of long half-life benzodiazepines in women, and frequent self-medication. The revised articles establish the importance of further study of the phenomenon of the use of benzodiazepines in our elderly population. Strikingly, scientific information is scarce, with most studies coming from only one country (Brazil). Moreover, most of them are transversal and descriptive, with few studies that explore long-term side effects, or specific hypotheses. Further studies should address these important issues.

Successful Treatment of Zolpidem Dependency with Replacement Benzodiazepine Therapy: A Case Study

Zolpidem is a non-benzodiazepine hypnotic drug used in short-term insomnia management. It is considered to be a safer drug than benzodiazepines. Zolpidem was initially considered to have lower incidences of dependence and tolerance than benzodiazepines. However, studies, have shown that zolpidem can lead to dependency. Although various cases of zolpidem dependence have been reported till date, but there is few published reports regards the medication to be used in the detoxification. We present a 21-year-old woman with history of zolpidem dependency. She had previously been using zolpidem for 3 years. She admitted and treated with replacement therapy with benzodiazepine. The equivalent diazepam was calculated (100 mg) and the replacement therapy consisted of 70 mg diazepam divided in doses of 20 mg in the morning, 20 mg midday, and 30 mg at night. A psychiatrist and a psychologist visited her in the morning and evening, respectively. Diazepam was tapered by 5 mg per day after 48 h; she was discharged when the dose was tapered to 60 mg per day with subsequent daily outpatient visits for continued dose tapering. Dose tapering was more gradual in comparison to the inpatient setting, namely by 5 mg every 5 days; overall, final tapering to a 20 mg daily dose took 60 days. She stopped diazepam usage after 65 days. She was followed-up for a 6-month period and urinary immunoassays ruled out benzodiazepine usage; all urinary tests were negative. This case of zolpidem dependency successfully treated by substitution with an equipotent, longer half-life benzodiazepine followed by tapering of benzodiazepine to discontinuation; this method can help in the prevention of seizures. Furthermore, it is advisable to manage replacement therapy in an inpatient setting. This method can help in the prevention of seizures. Meanwhile, it is advisable to manage replacement therapy in an inpatient setting.

Trends in incident use of benzodiazepines and Z-drugs in France from 2006 to 2012: a population-based study.

To study trends in incident use of benzodiazepines in France between 2006 and 2012. A cross-sectional study repeated yearly was conducted using data from the French national healthcare insurance system. New benzodiazepine users were defined as users without any benzodiazepine dispensing in the year prior to the first dispensing of benzodiazepine in each year. Relative changes in incidence of use were calculated with the year 2006 as reference; confidence intervals for changes were estimated using the bootstrap method. Over the study period, the incident use of benzodiazepines decreased from 6.2% to 5.9%; this corresponded to a 5.1% decrease (95%CI: -6.8% to -4.2%) for 2012 compared to 2006. The decrease mainly concerned hypnotics (-15.5%; -21.2% to -15.3%) and appeared more pronounced in people aged 18-44 years. Incident use of anxiolytics remained stable overall during the period (4.0% of the population). Within anxiolytics, incident use of long half-life benzodiazepines (bromazepam, prazepam) decreased in favor of short half-life benzodiazepines (alprazolam, oxazepam). This change concerned patients aged 65-79 and patients aged 80 years and over. Nevertheless, in 2012, nearly one third of incident users aged 65 years and over started a treatment with a long half-life benzodiazepine, mostly bromazepam. A limited decrease in incident benzodiazepine use was observed in France between 2006 and 2012 that concerned only hypnotics. Although congruent with recommendations, this improvement appears insufficient with regard to the level of exposure to these drugs in France. New actions especially targeting anxiolytic benzodiazepine use should be undertaken to consolidate these results. Copyright © 2016 John Wiley & Sons, Ltd.