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Ma TT, Wang Z, Qin X, Ju C, Lau WCY, Man KKC, Castle D, Chung Chang W, Chan AYL, Cheung ECL, Chui CSL, Wong ICK. Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008 to 2018: a sales data analysis. Sleep 2023; 46:zsad124. [PMID: 37094086 DOI: 10.1093/sleep/zsad124] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/16/2023] [Indexed: 04/26/2023] Open
Abstract
STUDY OBJECTIVES To investigate the trends in the consumption of benzodiazepines (BZDs) and Z-drugs at global, regional, and national levels from 2008 to 2018, across 67 countries and regions. METHODS This cross-sectional descriptive study investigated the consumption of BZDs and Z-drugs analyzed by global pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System database between 2008 and 2018. Consumption was measured in defined daily dose (DDD) per 1000 inhabitants per day (DDD/TID). The global, regional, and national trends were estimated using linear mixed models. Additional analyses were conducted by grouping countries by income level. The association between consumption and Gross Domestic Product (GDP) and the prevalence of different medical conditions was explored in univariable linear models. RESULTS BZD consumption decreased annually by -1.88% (95% CI: -2.27%, -1.48%), and Z-drugs increased by + 3.28% (+2.55%, +4.01%). In 2008, the top ten countries for BZD and Z-drug consumption were all European, ranging from 63.69 to 128.24 DDD/TID. Very low levels were found in Russia, Kuwait, United Arab Emirates, Saudi Arabia, French West Africa, and the Philippines, with DDD/TID < 1. The consumption in high-income countries was much higher than in middle-income countries. The results showed that increased consumption of BZDs and Z-drugs was statistically associated (p < 0.05) with higher GDP and increased prevalence of anxiety, self-harm, neurological disorders, chronic respiratory diseases, cardiovascular diseases, and cancers. CONCLUSIONS Distinct differences in consumption and trends of BZDs and Z-drugs were found across different countries and regions. Further exploration is needed to understand the association and safety of the use of BZDs and Z-drugs in patients with comorbidities.
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Affiliation(s)
- Tian-Tian Ma
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Zixuan Wang
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Xiwen Qin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Wallis C Y Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Castle
- Department of Psychiatry, University of Toronto, Canada
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- State Key Laboratory in Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China
| | - Adrienne Y L Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Unit of Pharmacotherapy Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Edmund C L Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Aston School of Pharmacy, Aston University, Birmingham, UK
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Alanazi AMM, Alqahtani MM, Alquaimi MM, Alotaibi TF, Algarni SS, Alonizi KM, Ismaeil TT, Gibson-Young L, Jayawardene WP. Epidemiological associations of asthma status and tobacco use, substance use, and substance misuse among adults in the United States, 2015-2019. J Asthma 2023; 60:87-95. [PMID: 35025703 DOI: 10.1080/02770903.2022.2029480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: Adults with asthma have a higher prevalence of substance use. However, knowledge is scarce regarding the associations between adults with asthma and tobacco use, substance use, and substance misuse. This study aimed to use national samples of United States adults to assess the comprehensive use and misuse of substances in adults with asthma.Method: This cross-sectional study comprised data drawn from the 2015 to 2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of asthma status (lifetime and current) with last month's tobacco use; substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, inhalants); and substance misuse (pain relievers, tranquilizers, stimulants, sedatives). All regression models were controlled for sociodemographic characteristics, comorbidity, last-month serious psychological distress, and co-substance use and misuse. Results: Adults with lifetime asthma (Nweighted = 115,600,887) were less likely to use cigarettes, cigars, smokeless tobacco, inhalants, and polyuse of any substance. In contrast, adults with current asthma (Nweighted = 765,096,31) were more likely to use pipe tobacco, cocaine, non-prescribed tranquilizers, and less likely to use polytobacco products. Adults with lifetime asthma were associated with fewer last-month tobacco and inhalant use than those without lifetime asthma. However, adults with current asthma were associated with greater last month's pipe tobacco, cocaine, and non-prescribed tranquilizers. Conclusion: Thus, further longitudinal studies are recommended among adults with asthma to effectively design tailored treatment and prevention interventions.
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Affiliation(s)
- Abdullah M M Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maher M Alquaimi
- Department of Respiratory Therapy, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Tareq F Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh S Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid M Alonizi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Taha T Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Wasantha P Jayawardene
- Institute for Research on Addictive Behavior, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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McLoughlin RF, McDonald VM. The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma. FRONTIERS IN ALLERGY 2022; 2:735030. [PMID: 35387051 PMCID: PMC8974714 DOI: 10.3389/falgy.2021.735030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Vernet R, Beeker N, Neuraz A, Blanco C, Olfson M, Airagnes G, Lemogne C, Alvarado JM, Arnaout M, Cougoule C, Meneton P, Limosin F. Association between benzodiazepine receptor agonist use and mortality in patients hospitalised for COVID-19: a multicentre observational study. Epidemiol Psychiatr Sci 2022; 31:e18. [PMID: 35352674 PMCID: PMC8967698 DOI: 10.1017/s2045796021000743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW). RESULTS Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74-3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31-1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08-2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment. CONCLUSIONS BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.
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Affiliation(s)
- N. Hoertel
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - M. Sánchez-Rico
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - E. Gulbins
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - J. Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - R. Vernet
- Medical Informatics, Biostatistics and Public Health Department, AP-HP, Centre-Université de Paris, Hôpital Européen Georges Pompidou, F-75015Paris, France
| | - N. Beeker
- Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - A. Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
- Department of Medical Informatics, AP-HP, Centre-Université de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - C. Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD20852, USA
| | - M. Olfson
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY10032, USA
| | - G. Airagnes
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
- INSERM, UMS 011, Population-based Epidemiologic Cohorts, Villejuif, France
| | - C. Lemogne
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, Paris, France
| | - J. M. Alvarado
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - M. Arnaout
- Anesthesia and Intensive Care Department, Hôpitaux Universitaires Paris Île-de-France Ouest, Boulogne-Billancourt, France
| | - C. Cougoule
- Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - P. Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - F. Limosin
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
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Johansson CJ, Nilsson PM, Ignell C. Early life exposures and risk of adult respiratory disease during 50 years of follow-up. Eur J Epidemiol 2020; 35:1157-1166. [PMID: 32270394 PMCID: PMC7762746 DOI: 10.1007/s10654-020-00626-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
Adult health is influenced by factors during fetal life affecting organ development and birth weight. We aimed to study such factors in relation to adult respiratory disease (ARD) risk. The Helsingborg Birth Cohort, Sweden, contributed baseline data collected by medical staff through clinical examination and questionnaires on maternal and birth characteristics 1964-1967. Register linkages were performed with completions of data on ARD by ICD 8-10 classifications (1969-2016), and/or ARD-related drug usage (2005-2016) enabling a 50-year follow-up time. Cox proportional hazard regression analyses were made to adjust for potential confounders, adjusted hazard ratio (aHR). A total of 3675 mothers and their offspring were included. Female offspring showed higher frequency of ARD than males, aHR 1.5 (95% CI 1.3-1.8). Maternal use of sedatives during second trimester, aHR 2.2 (95% CI 1.4-3.4), and maternal smoking during most of pregnancy, aHR 1.2 (95% CI 1.0-1.4), were associated with offspring ARD. Stratified by sex, large-for-gestational-age, aHR 1.4 (95% CI 1.0-1.9), was significantly associated with ARD in female offspring along with maternal sedative use during second trimester and maternal smoking during most of pregnancy. Maternal sedative use during second trimester or all trimesters were the only significant risk factors for male offspring. In conclusion, maternal sedative use in second trimester was independently associated with subsequent respiratory disease in adult offspring irrespective of sex.
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Affiliation(s)
- Carl J Johansson
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Internal Medicine, Skane University Hospital, Lund University, Malmö, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences, Internal Medicine, Skane University Hospital, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
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Luyster FS, Ritterband LM, Sereika SM, Buysse DJ, Wenzel SE, Strollo PJ. Internet-Based Cognitive-Behavioral Therapy for Insomnia in Adults With Asthma: A Pilot Study. Behav Sleep Med 2020; 18:10-22. [PMID: 30252506 PMCID: PMC6433549 DOI: 10.1080/15402002.2018.1518229] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background/Objective: Insomnia is common among adults with asthma and is associated with worse asthma control. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia with medical comorbidities, but it has not been tested in asthma. The purpose of this study was to assess the feasibility and acceptability of an Internet-based CBT-I intervention, called Sleep Healthy Using the Internet (SHUTi), among adults with asthma and comorbid insomnia, and to gather preliminary efficacy data on changes in insomnia severity, sleep quality, asthma control, and asthma-related quality of life. Methods: A single-group, pretest-posttest design was employed, where all participants completed the SHUTi program. Online questionnaires were completed pre- and postintervention. Individual telephone interviews were conducted after posttreatment data collection to obtain participants' experiences with SHUTi and suggestions for improvement. Results: The sample (N = 23) comprised men and women aged 18-75 years with moderate to severe, not well-controlled asthma, and comorbid insomnia. Nineteen (83%) completed postintervention assessments. Improvements on the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Asthma Control Test, and Asthma Quality of Life Questionnair-Marks were observed at postintervention. Data from the telephone interviews suggest that most participants had a positive experience with SHUTi. Participants suggested incorporating asthma-specific content into future versions of the intervention. Conclusions: Internet-based CBT-I is a potential treatment option for adults with asthma and comorbid insomnia.
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Affiliation(s)
- Faith S. Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Daniel J. Buysse
- Department of Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally E. Wenzel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick J. Strollo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Sake F, Wong K, Bartlett DJ, Saini B. Benzodiazepine usage and patient preference for alternative therapies: A descriptive study. Health Sci Rep 2019; 2:e116. [PMID: 31139756 PMCID: PMC6529930 DOI: 10.1002/hsr2.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS The prevalence of chronic benzodiazepine use in primary care settings remains high despite clear evidence of adverse health outcomes resulting from long-term use and the availability of effective alternative behavioural therapies. Eliciting factors influencing past or current usage experience of benzodiazepine users and their future behavioural intention regarding discontinuation or alternative behavioural therapy adoption could be useful in developing informed strategies facilitating successful benzodiazepine withdrawal in long-term users. The aim of this study was to identify patient factors influencing their current long-term benzodiazepine use, past withdrawal attempt, and future intention to trial safer alternative behavioural therapies. Additionally, the study also aimed to explore patients' preference for information sources on behavioural therapies. METHODS Point of purchase surveys were conducted with patients obtaining benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included the Beliefs about Medicines Questionnaire (BMQ-specific), questions about patient's sociodemographic characteristics, as well as their views about long-term benzodiazepine use and behavioural therapies. RESULTS Seventy-five patients were recruited from 12 pharmacies across New South Wales (NSW). The surveys were conducted from November 2016 to July 2017. The mean (±SD) age of the participants was 54.3 (±16.7) with a range of 23 to 86 years, and 67% of the participants had been using the benzodiazepine for at least 1 year. Lower-education levels, stronger beliefs about the necessity of use, and lower concerns about ongoing benzodiazepine use were significantly associated with prolonged use. Sixty-four percent of the participants were not interested in behavioural therapies, and there was a significant relationship between the participants' future preference for behavioural therapies and their concerns about the potential adverse effects of benzodiazepines. A majority of the participants rated general practitioners (GPs) as their first choice and pharmacists as the second choice for discussing behavioural therapies. CONCLUSIONS Specific individual sociodemographic characteristics of benzodiazepine users and their medication-related beliefs influence their current benzodiazepine usage and future intention to trial behavioural therapies as an alternative to their benzodiazepines. Based on the reported preferences of benzodiazepine users in this study, developing and evaluating GP-pharmacist collaborative services to improve the uptake of behavioural therapies as an alternative to benzodiazepines can be recommended.
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Affiliation(s)
- Fatema‐Tun‐Naher Sake
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Keith Wong
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownAustralia
| | - Delwyn J. Bartlett
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
| | - Bandana Saini
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
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8
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Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D 2018; 17:493-507. [PMID: 28865038 PMCID: PMC5694420 DOI: 10.1007/s40268-017-0207-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.
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9
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Bedse G, Bluett RJ, Patrick TA, Romness NK, Gaulden AD, Kingsley PJ, Plath N, Marnett LJ, Patel S. Therapeutic endocannabinoid augmentation for mood and anxiety disorders: comparative profiling of FAAH, MAGL and dual inhibitors. Transl Psychiatry 2018; 8:92. [PMID: 29695817 PMCID: PMC5917016 DOI: 10.1038/s41398-018-0141-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/28/2017] [Accepted: 02/22/2018] [Indexed: 12/23/2022] Open
Abstract
Recent studies have demonstrated anxiolytic potential of pharmacological endocannabinoid (eCB) augmentation approaches in a variety of preclinical models. Pharmacological inhibition of endocannabinoid-degrading enzymes, such as fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL), elicit promising anxiolytic effects in rodent models with limited adverse behavioral effects, however, the efficacy of dual FAAH/MAGL inhibition has not been investigated. In the present study, we compared the effects of FAAH (PF-3845), MAGL (JZL184) and dual FAAH/MAGL (JZL195) inhibitors on (1) anxiety-like behaviors under non-stressed and stressed conditions, (2) locomotor activity and body temperature, (3) lipid levels in the brain and (4) cognitive functions. Behavioral analysis showed that PF-3845 or JZL184, but not JZL195, was able to prevent restraint stress-induced anxiety in the light-dark box assay when administered before stress exposure. Moreover, JZL195 treatment was not able to reverse foot shock-induced anxiety-like behavior in the elevated zero maze or light-dark box. JZL195, but not PF-3845 or JZL184, decreased body temperature and increased anxiety-like behavior in the open-field test. Overall, JZL195 did not show anxiolytic efficacy and the effects of JZL184 were more robust than that of PF-3845 in the models examined. These results showed that increasing either endogenous AEA or 2-AG separately produces anti-anxiety effects under stressful conditions but the same effects are not obtained from simultaneously increasing both AEA and 2-AG.
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Affiliation(s)
- Gaurav Bedse
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Rebecca J. Bluett
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA ,0000 0001 2264 7217grid.152326.1Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
| | - Toni A. Patrick
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Nicole K. Romness
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Andrew D. Gaulden
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Philip J. Kingsley
- 0000 0001 2264 7217grid.152326.1Departments of Biochemistry, Chemistry, and Pharmacology, A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Vanderbilt Institute of Chemical Biology, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Niels Plath
- 0000 0004 0476 7612grid.424580.fH. Lundbeck A/S, Copenhagen, Denmark
| | - Lawrence J. Marnett
- 0000 0001 2264 7217grid.152326.1Departments of Biochemistry, Chemistry, and Pharmacology, A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Vanderbilt Institute of Chemical Biology, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Sachin Patel
- 0000 0004 1936 9916grid.412807.8Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA ,0000 0001 2264 7217grid.152326.1Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA ,0000 0001 2264 7217grid.152326.1Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN USA
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Taipale H, Tolppanen AM, Koponen M, Tanskanen A, Lavikainen P, Sund R, Tiihonen J, Hartikainen S. Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease. CMAJ 2017; 189:E519-E529. [PMID: 28396328 DOI: 10.1503/cmaj.160126] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge regarding whether benzodiazepines and similarly acting non-benzodiazepines (Z-drugs) are associated with an increased risk of pneumonia among older adults is lacking. We sought to investigate this association among community-dwelling adults with Alzheimer disease, a condition in which both sedative/hypnotic use and pneumonia are common. METHODS We obtained data on all community-dwelling adults with a recent diagnosis of Alzheimer disease in Finland (2005-2011) from the Medication use and Alzheimer disease (MEDALZ) cohort, which incorporates national registry data on prescriptions, reimbursement, hospital discharges and causes of death. Incident users of benzodiazepines and Z-drugs were identified using a 1-year washout period and matched with nonusers using propensity scores. The association with hospital admission or death due to pneumonia was analyzed with the Cox proportional hazards model and adjusted for use of other psychotropic drugs in a time-dependent manner. RESULTS Among 49 484 eligible participants with Alzheimer disease, 5232 taking benzodiazepines and 3269 taking Z-drugs were matched 1:1 with those not taking these drugs. Collectively, use of benzodiazepines and Z-drugs was associated with an increased risk of pneumonia (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05-1.42). When analyzed separately, benzodiazepine use was significantly associated with an increased risk of pneumonia (adjusted HR 1.28, 95% CI 1.07-1.54), whereas Z-drug use was not (adjusted HR 1.10, 95% CI 0.84-1.44). The risk of pneumonia was greatest within the first 30 days of benzodiazepine use (HR 2.09, 95% CI 1.26-3.48). INTERPRETATION Benzodiazepine use was associated with an increased risk of pneumonia among patients with Alzheimer disease. Risk of pneumonia should be considered when weighing the benefits and risks of benzodiazepines in this population.
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Affiliation(s)
- Heidi Taipale
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Piia Lavikainen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Reijo Sund
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Jari Tiihonen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
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Marra A, Pandharipande PP. The evolving approach to sedation in ventilated patients: a real world perspective. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:494. [PMID: 28149856 DOI: 10.21037/atm.2016.12.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Annachiara Marra
- Department of Medicine, Division of Allergy and Pulmonary Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA; ; Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Pratik P Pandharipande
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Abstract
Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.
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Affiliation(s)
- Daniel F Kripke
- UCSD, 8437 Sugarman Drive, La Jolla, CA, 92037-2226, USA. .,Scripps Clinic Viterbi Family Sleep Center, La Jolla, USA.
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13
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Niedrig DF, Hoppe L, Mächler S, Russmann H, Russmann S. Benzodiazepine Use During Hospitalization: Automated Identification of Potential Medication Errors and Systematic Assessment of Preventable Adverse Events. PLoS One 2016; 11:e0163224. [PMID: 27711224 PMCID: PMC5053537 DOI: 10.1371/journal.pone.0163224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Benzodiazepines and “Z-drug” GABA-receptor modulators (BDZ) are among the most frequently used drugs in hospitals. Adverse drug events (ADE) associated with BDZ can be the result of preventable medication errors (ME) related to dosing, drug interactions and comorbidities. The present study evaluated inpatient use of BDZ and related ME and ADE. Methods We conducted an observational study within a pharmacoepidemiological database derived from the clinical information system of a tertiary care hospital. We developed algorithms that identified dosing errors and interacting comedication for all administered BDZ. Associated ADE and risk factors were validated in medical records. Results Among 53,081 patients contributing 495,813 patient-days BDZ were administered to 25,626 patients (48.3%) on 115,150 patient-days (23.2%). We identified 3,372 patient-days (2.9%) with comedication that inhibits BDZ metabolism, and 1,197 (1.0%) with lorazepam administration in severe renal impairment. After validation we classified 134, 56, 12, and 3 cases involving lorazepam, zolpidem, midazolam and triazolam, respectively, as clinically relevant ME. Among those there were 23 cases with associated adverse drug events, including severe CNS-depression, falls with subsequent injuries and severe dyspnea. Causality for BDZ was formally assessed as ‘possible’ or ‘probable’ in 20 of those cases. Four cases with ME and associated severe ADE required administration of the BDZ antagonist flumazenil. Conclusions BDZ use was remarkably high in the studied setting, frequently involved potential ME related to dosing, co-medication and comorbidities, and rarely cases with associated ADE. We propose the implementation of automated ME screening and validation for the prevention of BDZ-related ADE.
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Affiliation(s)
- David Franklin Niedrig
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
- Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, ZH Switzerland
| | - Liesa Hoppe
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
| | | | | | - Stefan Russmann
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich ZH, Switzerland
- Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, ZH Switzerland
- drugsafety.ch, Küsnacht ZH, Switzerland
- * E-mail:
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14
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Nakafero G, Sanders RD, Nguyen-Van-Tam JS, Myles PR. The association between benzodiazepines and influenza-like illness-related pneumonia and mortality: a survival analysis using UK Primary Care data. Pharmacoepidemiol Drug Saf 2016; 25:1263-1273. [PMID: 27215827 DOI: 10.1002/pds.4028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Bacterial superinfections, including pneumonia, are frequent complications of influenza-like illness (ILI). Clinical and laboratory evidence suggests that benzodiazepines and Z-drugs may influence susceptibility to infections and mortality. We investigated whether benzodiazepines and zopiclone modify the occurrence of ILI-related pneumonia and mortality. METHODS We obtained data on 804 051 ILI patients from a comprehensive primary care database, the Clinical Practice Research Datalink. The follow-up period started from the diagnosis of ILI for 30 days. Pneumonia and deaths occurring within the 30-day follow-up period were considered as potentially 'ILI related'. Exposure to benzodiazepines and zopiclone was determined in the period preceding a diagnosis of ILI with current use defined as a prescription for benzodiazepines in the month prior to ILI diagnosis. Cox regression was used for the analyses. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) are presented. RESULTS Influenza-like illness-related pneumonia and mortality were noted in 1117 and 707 ILI patients, respectively. Current exposure to benzodiazepines was associated with increased occurrence of both ILI-related pneumonia and mortality (ILI-related pneumonia adjusted HR 4.24, 95%CI [2.27, 7.95]; ILI-related mortality adjusted HR 20.69, 95%CI [15.54, 27.54]). A similar increase in ILI-related mortality but not pneumonia was observed with current zopiclone use (ILI-related mortality adjusted HR 10.86, 95%CI [6.93, 17.02]; ILI-related pneumonia adjusted HR 1.97, 95%CI [0.63, 6.12]). CONCLUSION Benzodiazepines may increase the likelihood of pneumonia and mortality related to ILI. A cautionary approach to prescribing benzodiazepine is suggested in people known to be at increased risk of pneumonia or mortality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Georgina Nakafero
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | - Robert D Sanders
- Department of Anaesthesiology, University of Wisconsin, Madison, WI, USA
| | | | - Puja R Myles
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 09/02/2023] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics' mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Abstract
This is a review of hypnotic drug risks and benefits. Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality (especially overdose deaths, quiet deaths at night, and suicides), infections, cancer, depression, automobile crashes, falls, other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with even greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse (not better) and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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