Patterns of hypnotic drug prescription in Italy

1997 ◽  
Vol 170 (2) ◽  
pp. 176-180 ◽  
Author(s):  
M. Balestrieri ◽  
M. Bortolomasi ◽  
M. Galletta ◽  
C. Bellantuono
Keyword(s):  
General Practice ◽  
Drug Prescription ◽  
Community Sample ◽  
The Elderly ◽  
Short Acting ◽  
Large Cities ◽  
Hypnotic Drug ◽  
North Eastern ◽  
Hypnotic Drugs ◽  
One Year

BackgroundIn Italy a number of studies have been published on psychotropic drug use in general practice and community settings. However, the present study is the first Italian study to focus on hypnotic drug prescriptions in a large community sample.MethodData were collected from 145 of the total of 404 pharmacies of five large cities in north-eastern Italy. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period.ResultsThe pharmacists interviewed 7/44 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority (96%) of prescriptions were for benzodiazepines, with lorazepam and triazolam accounting for 50%. Short-acting and ultra-short-acting benzodiazepines were more frequently prescribed for sleep induction by general practitioners (GPs) than by psychiatrists and other physicians. Frequently the benzodiazepine used as a hypnotic was also prescribed for day time sedation. Approximately 72% of subjects reported they had been taking the prescribed drug for one year or more.ConclusionsIn Italy benzodiazepines are the most frequently prescribed drugs for sleep induction; as they are widely prescribed for elderly people by GPs often for long periods of time, educational programmes and guidelines on the rational use of benzodiazepines in general practice are needed.

Abstract 052: Short-acting Hypnotic Drugs Increase Mortality and Obese Patients are Particularly Vulnerable

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Robert D Langer ◽  
Daniel F Kripke ◽  
Lawrence E Kline
Keyword(s):  
Excess Mortality ◽  
Poor Sleep ◽  
Obese Patients ◽  
Cox Models ◽  
Short Acting ◽  
Hypnotic Drug ◽  
Hazard Ratios ◽  
Levels Of Use ◽  
Low Levels ◽  
Hypnotic Drugs

Background: An estimated 6% – 10% of U.S. adults took a hypnotic drug for poor sleep in 2010. At least 18 studies have reported significant (p<0.05) associations of hypnotic usage with increased mortality. However, most lacked data on newer, supposedly safer, short-acting drugs, and had limited control for confounding by health status. Furthermore, little is known regarding potentially heightened risks in specific vulnerable populations. Objective: The present study was designed to test whether newer short-acting hypnotic drugs were associated with increased mortality after controlling for comorbid conditions, and to assess risks within subgroups of patients with specific medical conditions. Methods: Using electronic medical records from a large U.S. health system the authors conducted a one-to-two matched-cohort survival analysis of associations between hypnotic drug use and mortality. Records were extracted for 10,529 hypnotic users and 23,676 matched controls with no hypnotic prescriptions, mean age 54 years, followed for an average of 2.5 years between 2002 and 2006. Hazard ratios (HR) for death were computed from Cox models controlled for risk factors and stratified on comorbidites. Results: The short-acting drugs zolpidem (41%) and temazapam (20%) accounted for the majority of use. Patients prescribed any hypnotic had substantially elevated hazards of dying compared to non-users. Importantly, the death hazard was evident even in the lowest tertile, 1 to 18 pills per year, HR 3.60 (95% Confidence Interval, 2.92 – 4.44). HRs for the remaining tertiles were 4.43 (3.67 – 5.36) and 5.32 (4.50 – 6.30), demonstrating a dose-response association. HR were robust within subgroups restricted to users and non-users with identical comorbidity, implying that selective use of hypnotics by patients in poor health was an unlikely explanation for the excess mortality. Obesity emerged as a marker of increased vulnerability. Among 2206 patients with a diagnosis of obesity, (mean BMI 38.8), the mortality HRs by hypnotic tertile were 8.07 (3.64 – 17.89), 6.37 (2.73 – 14.88), and 9.34 (4.47 – 19.52). Additional models were fitted for patients with the combination of Obesity + Diabetes + Hypertension to evaluate the possibility that this risk was driven by metabolic syndrome. HRs for that combination were slightly lower than those for obesity alone, suggesting that obesity was the primary factor. Conclusions: Short-acting hypnotics were associated with a more than 3-fold increased hazard of death that, even at low levels of use. Obese patients appear particularly vulnerable, perhaps through interaction with sleep apnea. Emerging evidence for substantial harm, even with limited exposure to hypnotics, should be weighed against any benefits.

Hypnotic Drug Use in Spain: A Cross-Sectional Study Based on a Network of Community Pharmacies

1996 ◽  
Vol 30 (10) ◽  
pp. 1092-1100 ◽  
Author(s):  
Pilar Rayón ◽  
Mariantonia Serrano-Castro ◽  
Horacio del Barrio ◽  
Carmen Alvarez ◽  
Dolores Montero ◽  
...  
Keyword(s):  
Drug Use ◽  
Sleep Disorder ◽  
General Practitioners ◽  
The Elderly ◽  
Community Pharmacies ◽  
Cross Sectional ◽  
Hypnotic Drug ◽  
Hypnotic Drugs ◽  
Long Action

OBJECTIVE: To investigate how hypnotic drugs are used in Spain, specifically, (1) to characterize the user population in some simple demographic (e.g., sex, age) and clinical (e.g., type of insomnia, type of physician who prescribed the drug) variables; (2) to estimate the proportion of long-term users (>3 mo); (3) to determine the frequency of different administration schedules; (4) to determine whether the kind of hypnotic drug prescribed according to the duration of its effect correlates with the type of sleep disorder or patient age; and (5) to compare the dosage used by the elderly with that used by adults. DESIGN: Cross-sectional pharmacy-based study. SETTING: A network of 318 community pharmacies throughout Spain. SUBJECTS: Patients (n = 5324) requesting a hypnotic drug for insomnia who agreed to take part in the study. MAIN OUTCOME MEASURES: Distribution of the use of hypnotic drugs by age, sex, type of insomnia, type of physician, specific hypnotic drug, daily dosage, treatment schedule, and duration of treatment. RESULTS: Women (67%) and the elderly (58%) constituted the largest subgroups in the sample. Difficulties in sleep onset and in sleep maintenance as single disorders were reported by 38% and 37% of users, respectively. Prescriptions were written by general practitioners in 80% of cases. Daily use was reported by 88% and long-term use (>3 mo) by 72% of the users. Long-term treatment was two- to threefold more frequent in the elderly than in middle-aged subjects. Intermediate-action hypnotic drugs were used by 59% of subjects, short-action drugs by 24%, and long-action drugs by 17%. The type of hypnotic drug prescribed was not related to the kind of sleep disorder or the age of patients. Specialists prescribed long-action hypnotic drugs more often than did general practitioners. No relevant differences were observed between dosages used by the elderly and those used by adults. In both groups the dosage taken by most patients, regardless of the drug, corresponded to the available strength. Substitution drugs for triazolam belonged to the intermediate-action class in 53% of the cases. CONCLUSIONS: Recommendations on hypnotic drug use are largely not followed in Spain. Most patients are taking hypnotic drugs daily, over long time periods, and without an adequate dosage titration according to age. Measures should be taken to correct this situation.

scholarly journals Concomitant alcohol and sedative-hypnotic drug use among the elderly in Norway

2017 ◽  
Vol 34 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Elin Kristin Bye ◽  
Ingeborg Rossow
Keyword(s):  
Drug Use ◽  
Age Groups ◽  
The Elderly ◽  
Cross Sectional ◽  
Sleeping Pills ◽  
Hypnotic Drug ◽  
Hazardous Alcohol ◽  
High Risk Factor ◽  
Hypnotic Drugs ◽  
Alcohol Users

Background: Sedative-hypnotic drugs (i.e., tranquilizers and sleeping pills) are more often used among the elderly compared to other age groups. Concomitant use of alcohol and sedative-hypnotic drugs constitutes a particularly high risk factor for accidental injuries among the elderly. However, few studies have addressed the prevalence of concomitant alcohol and sedative-hypnotic drug use and knowledge about the characteristics of such use is meagre. Aim: To assess the prevalence of concomitant alcohol and sedative-hypnotic drug use among elderly people and to explore the characteristics of such concomitant use. Data and method: Data stemmed from cross-sectional population surveys in Norway, conducted in the period 2012–2015 (sub-sample 60–79 years: N = 1920). Results: Respondents reported frequencies of use of sedatives (tranquilizers), hypnotics (sleeping pills) and alcohol consumption in the preceding 12 months. Sedative-hypnotic drug use was reported by 25%, and 19% reported both such drug use and alcohol use in the past year. Concomitant use, suggesting simultaneous intake of alcohol and drugs, was reported by 6%. Conclusions: Concomitant use was more often reported by women, hazardous alcohol users, non-working respondents, and by those in the lower income groups and those living alone. Health personnel need to take into consideration the risks associated with concomitant use and to inform their patients accordingly.

Evaluation of insomnia management in the elderly by general practitioners

2017 ◽  
Vol 41 (S1) ◽  
pp. s856-s856
Author(s):  
M. Turki ◽  
J. Aloulou ◽  
N. Halouani ◽  
R. Ennaoui ◽  
O. Amami
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
The Elderly ◽  
Descriptive Study ◽  
Accurate Diagnosis ◽  
Physiological Changes ◽  
Cross Sectional ◽  
Somatic Comorbidities ◽  
Hypnotic Drugs ◽  
Competing Interest

IntroductionInsomnia is the most common sleep disorder in the elderly. Its management must take into account the physiological changes associated with age, a higher frequency of comorbidities and polypharmacy.AimTo evaluate the management of insomnia in the elderly patients by general practitioners and to compare it with international recommendations.MethodsWe conducted a cross-sectional and descriptive study among general practitioners in Sfax over a period of two months (January and February 2016). We proposed to these doctors to participate in our study by sending to them a questionnaire in their emails, which they fill anonymously.ResultsA total of 32 doctors responded to the questionnaire. Among them, 62.5% reported that they often or very often receive elderly consulting for insomnia. Before prescribing hypnotic drugs, 65.6% of practitioners reported that they often advise lifestyle and dietary rules. The most prescribed hypnotic classes were: benzodiazepines (BZD) 59.37%; antihistamines 59.37% and homeopathic treatments 56.25%. In the last prescription, the treatment period exceeded 30 days in 18.75%. As for the prescription of BZD, molecules with long half-life were used in 37.48% of cases, and the dosage was identical to adult in 34.4% of cases.ConclusionThe prescription of hypnotic treatment in the elderly meets a logical approach to care, after an accurate diagnosis, taking into account psychiatric and somatic comorbidities, the precautions and contraindications. In this context, we have identified several shortcomings in the management of insomnia in the elderly in general practice. A multiplication of training on this subject is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Changing Patterns of Psychotropic Drug use in the Elderly: A Five-Year Update

DICP ◽  
1989 ◽  
Vol 23 (7-8) ◽  
pp. 610-613 ◽  
Author(s):  
Ronald B. Stewart ◽  
Franklin E. May ◽  
Mary T. Moore ◽  
William E. Hale
Keyword(s):  
Drug Use ◽  
Psychotropic Drug ◽  
Half Life ◽  
The Elderly ◽  
Elderly Subjects ◽  
Short Acting ◽  
Psychotropic Drug Use ◽  
Changing Patterns ◽  
Hypnotic Drugs ◽  
Long Acting

Psychotropic drug use was evaluated in 2022 ambulatory elderly subjects in 1978-80 and again in 1984-86. Use of hypnotic drugs declined from 8.5 percent (n = 3234) in 1978-80 to 6.3 percent (n = 2681) in 1984-86 (p<0.01). Use of the long-acting hypnotic flurazepam decreased (p <0.01) and use of two short-acting drugs, triazolam and temazepam, increased. Prescribing of long half-life benzodiazepines, such as diazepam (p<0.01) and chlordiazepoxide, clorazepate, halazepam, and prazepam as a group (p <0.01) decreased as well as the use of nearly all products containing barbiturates (p<0.01).

scholarly journals Knee Pain as the Reason for Encounter in General Practice

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Thomas Frese ◽  
Linda Peyton ◽  
Jarmila Mahlmeister ◽  
Hagen Sandholzer
Keyword(s):  
General Practice ◽  
Knee Pain ◽  
Musculoskeletal Diseases ◽  
Drug Prescription ◽  
Osteoarthritis Of The Knee ◽  
Main Concern ◽  
Cross Sectional ◽  
Therapeutic Procedures ◽  
Transition Project ◽  
One Year

Objective. Currently, an overview of the management of knee pain in general practitioner’s offices is not available. The main concern of this study was to evaluate the consultation prevalence of knee pain, accompanying symptoms, the frequency of diagnostic and therapeutic procedures, and results of encounters of patients suffering from knee pain. Methods. For the SESAM 2 study cross-sectional data was collected from randomly selected patients during one year and compared with publicly available data from the Dutch Transition Project. Results. Overall, 127 out of 8,877 (1.4%) patients of the SESAM 2 study and 6,754 out of 149,238 (4.5%) patients of the Dutch Transition Project consulted for knee pain. Drug prescription, follow-up consultation, giving doctor’s advice, and referral to a specialist or physiotherapist were the most frequent procedures. Osteoarthritis of the knee and other musculoskeletal diseases were the most frequent results of encounter. Overweight, age, gender, and other musculoskeletal diseases were found to be significantly associated with knee pain. Conclusion. Knee pain in general practice settings is mainly associated with chronic problems. Dangerous outcomes (as suspected fracture or thrombosis) are rare. Further research is needed in order to reduce the influence knee pain has on daily living.

MALIGNANT MELANOMA. EPIDEMIOLOGY, ANALYTICAL INDICATORS OF THE EFFECTIVENESS OF ONCOLOGICAL SERVICES (POPULATION-BASED STUDY)

2017 ◽  
Vol 63 (2) ◽  
pp. 221-233
Author(s):  
Vakhtang Merabishvili
Keyword(s):  
Malignant Melanoma ◽  
Malignant Tumors ◽  
The Elderly ◽  
Population Based ◽  
Special Treatment ◽  
Detailed Structure ◽  
Population Based Study ◽  
Early Stages ◽  
One Year ◽  
Melanoma Epidemiology

Malignant melanoma of the skin (MMS) is less than 2% (1.74%) among all malignant tumors in Russia but this is more than 10,000 (10236-2015) of new cases. It is important to monitor the trend in dynamics of morbidity and mortality from this cause. From 1995 to 2015 a number of MMS primary cases was more than doubled in absolute numbers and “crude” rates. A slightly smaller increase is indicated by standardized indicators - 62.5% for men and 70.2% for women. Annually in Russia 3670 people die from MMS (2015), which is 1.2% of all cancer deaths. In recent years the previously revealed regularities have been largely preserved: lower rates of specific gravity detected in the early stages among people in the elderly and senile and in a smaller proportion in this group who received special treatment. At the same time a change in the detailed structure of the incidence of women has been revealed where currently the leading localization of MMS was not the lower extremities but the back. The index accuracy improved however the official statistics of the distribution of patients by stages of a disease was significantly distorted (weight of the early stages was increased from the real values). The index of one-year lethality and survival was significantly improved.

The Depressed Elderly Living in the Community

1990 ◽  
Vol 157 (3) ◽  
pp. 425-427 ◽  
Author(s):  
O. Ben-Arie ◽  
M. Welman ◽  
A. F. Teggin
Keyword(s):  
Depressive Disorder ◽  
The Elderly ◽  
Community Survey ◽  
One Year ◽  
Elderly Living ◽  
Course Of Depression

In a 1982 community survey, 23 elderly respondents were rated as having a depressive disorder by catego. Twenty survivors were followed up three and a half years later. The depression had remitted within one year in seven cases but nine were still depressed. There is a need for ongoing education of GPs about the recognition and course of depression in the elderly.

scholarly journals Hypnotic drug use for the elderly

BMJ ◽  
1988 ◽  
Vol 296 (6626) ◽  
pp. 930-930 ◽  
Author(s):  
K. Morgan
Keyword(s):  
Drug Use ◽  
The Elderly ◽  
Hypnotic Drug
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