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Fagiolini A, González Pinto A, Miskowiak KW, Morgado P, Young AH, Vieta E. Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights. Neuropsychiatr Dis Treat 2023; 19:2817-2831. [PMID: 38155994 PMCID: PMC10753355 DOI: 10.2147/ndt.s434130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Major depressive disorder (MDD) often co-occurs with dementia and other neurological disorders, and treatment with antidepressants can improve symptoms, quality of life, and survival in these patients. This narrative review provides an expert opinion about the role and effectiveness of trazodone in the treatment of older adults with MDD and cognitive impairment due to physical illnesses, such as dementia. Results Because of its mechanism of action, trazodone can treat several depression symptoms often seen in people with dementia, including insomnia, agitation, anxiety, cognitive impairment, and irritability. Conclusion Trazodone may be beneficial for patients with dementia or other neurological disorders comorbid with MDD, especially when the clinical picture of depression includes or is comorbid to symptoms of insomnia, irritability, inner tension, anxiety, or psychomotor agitation.
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Affiliation(s)
- Andrea Fagiolini
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena School of Medicine, Siena, 53100, Italy
| | - Ana González Pinto
- Bioaraba Research Institute, Department of Psychiatry, Araba University Hospital, Vitoria, 01004, Spain
- CIBERSAM, University of the Basque Country, Vitoria, Spain
| | - Kamilla Woznica Miskowiak
- Neurocognition and Emotion in Affective Disorders Centre (NEAD), Psychiatric Centre Copenhagen, Mental Health Services, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, 4710-057, Portugal
- Clinical Academic Center-Braga (2CA), Braga, 4710-243, Portugal
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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2
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Safety and efficacy of melatonin, clonazepam, and trazodone in patients with Parkinson’s disease and sleep disorders: a randomized, double-blind trial. Neurol Sci 2022; 43:6141-6148. [DOI: 10.1007/s10072-022-06188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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Seguro I, Rebelo P, Pacheco JG, Delerue-Matos C. Electropolymerized, Molecularly Imprinted Polymer on a Screen-Printed Electrode-A Simple, Fast, and Disposable Voltammetric Sensor for Trazodone. SENSORS 2022; 22:s22072819. [PMID: 35408433 PMCID: PMC9003412 DOI: 10.3390/s22072819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 01/27/2023]
Abstract
In recent years, analytical chemistry has been facing new challenges, particularly in developing low-cost, green, and easy-to-reproduce methods. In this work, a simple, reproducible, and low-cost electrochemical (voltammetric) molecularly imprinted polymer (MIP) sensor was designed specifically for the detection of trazodone (TZD). Trazodone (TZD) is an antidepressant drug consumed worldwide since the 1970s. By combining electropolymerization (surface imprinting) with screen-printed electrodes (SPCEs), the sensor is easy to prepare, is environmentally friendly (uses small amounts of reagents), and can be used for in situ analysis through integration with small, portable devices. The MIP was obtained using cyclic voltammetry (CV), using 4-aminobenzoic acid (4-ABA) as the functional monomer in the presence of TZF molecules in 0.1 M HCl. Non-imprinted control was also constructed in the absence of TZD. Both polymers were characterized using CV, and TZD detection was performed with DPV using the oxidation of TZD. The polymerization conditions were studied and optimized. Comparing the TZD signal for MIP/SPCE and NIP/SPCE, an imprinting factor of 71 was estimated, indicating successful imprinting of the TZD molecules within the polymeric matrix. The analytical response was linear in the range of 5–80 µM, and an LOD of 1.6 µM was estimated. Selectivity was evaluated by testing the sensor for molecules with a similar structure to TZD, and the ability of MIP/SPCE to selectively bind to TZD was proven. The sensor was applied to spiked tap water samples and human serum with good recoveries and allowed for a fast analysis (around 30 min).
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4
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Alqdwah-Fattouh R, Rodríguez-Martín S, Barreira-Hernández D, Izquierdo-Esteban L, Gil M, González-Bermejo D, Fernández-Antón E, Rodríguez-Miguel A, García-Lledó A, Bolúmar F, de Abajo FJ. Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study. Stroke 2022; 53:1560-1569. [PMID: 35109681 DOI: 10.1161/strokeaha.121.036661] [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: 11/16/2022]
Abstract
BACKGROUND Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. METHODS A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. RESULTS A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97-1.34) as compared with nonusers, 0.94 (95% CI, 0.77-1.13) as compared with past-users and 0.74 (95% CI, 0.58-0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (≤1, >1 year), sex, age (<70, ≥70 years old) and background vascular risk. CONCLUSIONS The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.
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Affiliation(s)
- Rasha Alqdwah-Fattouh
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (R.A.-F., F.B.)
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Diana Barreira-Hernández
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Laura Izquierdo-Esteban
- Stroke Unit, Department of Neurology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (L.I.-E.)
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain (M.G., D.G.-B.)
| | - Diana González-Bermejo
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain (M.G., D.G.-B.)
| | - Encarnación Fernández-Antón
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
| | - Alberto García-Lledó
- Department of Cardiology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (A.G.-L.).,Department of Medicine, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (A.G.-L.)
| | - Francisco Bolúmar
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain (R.A.-F., F.B.).,Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York (F.B.).,CIBERESP, Spain (F.B.)
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.).,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain (S.R.-M., D.B.-H., E.F.-A., A.R.M., F.J.d.A.)
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5
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Pardo-Cabello AJ, Manzano-Gamero V, Luna-Del Castillo JD. Adverse drug reactions among the most used hypnotic drugs in Spain. Rev Clin Esp 2021; 221:128-130. [PMID: 33138943 DOI: 10.1016/j.rce.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Affiliation(s)
- A J Pardo-Cabello
- Servicio de Medicina Interna, Hospital Universitario San Cecilio, Granada, España.
| | - V Manzano-Gamero
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J D Luna-Del Castillo
- Departamento de Bioestadística, Facultad de Medicina, Universidad de Granada, Granada, España
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6
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Pardo-Cabello AJ, Manzano-Gamero V, Luna-Del Castillo JD. Adverse drug reactions among the most used hypnotic drugs in Spain. Rev Clin Esp 2020; 221:128-130. [PMID: 33998490 DOI: 10.1016/j.rceng.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- A J Pardo-Cabello
- Servicio de Medicina Interna, Hospital Universitario San Cecilio, Granada, Spain.
| | - V Manzano-Gamero
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J D Luna-Del Castillo
- Departamento de Bioestadística, Facultad de Medicina, Universidad de Granada, Granada, Spain
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7
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García-García R, Calleja-Hernández MÁ. Discontinuation of cholinesterase inhibitor treatment in institutionalised patients with advanced dementia. Eur J Hosp Pharm 2020; 29:145-150. [PMID: 32723787 PMCID: PMC9047926 DOI: 10.1136/ejhpharm-2019-002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the impact of discontinuation of treatment with cholinesterase inhibitors (ChEIs) on cognitive, behavioural and functional outcomes in patients with severe dementia. METHODS A prospective observational study in which the prescribing physician decides, depending on multidisciplinary assessment and following the recommendations of the clinical practice guidelines, whether to withdraw or continue ChEI treatment in institutionalised patients, with a follow-up of 3 months. Cognitive abilities were measured using the Mini-Mental State Examination (MMSE) and Reisberg's Global Deterioration Scale (GDS). Other measures were the behavioural and psychological symptoms of dementia (BPSD) according to the Neuropsychiatric Inventory (NPI), the activities of daily living using the Barthel index, the pharmacological and the non-pharmacological measures to treat the BPSD. RESULTS ChEI treatment was discontinued in 23 of 43 patients. After 3 months there were no differences in MMSE (p=0.441), GDS (p=0.976), NPI (p=0.882) or Barthel index (p=0.080) scores, or the establishing of new pharmacological measures (p=0.919) or non-pharmacological measures (p=0.832). CONCLUSIONS ChEI discontinuation in advanced stage dementia was not related to clinical deterioration in terms of cognitive function, BPSD, or functional status. Discontinuing ChEI treatment according to a multidisciplinary assessment and the recommendation of the guidelines appears to be a possible way of optimising pharmacotherapy without altering the main clinical evaluation scales.
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Affiliation(s)
- Ramón García-García
- Pharmacy, Hospital Universitario de Torrevieja, Torrevieja, Spain .,University of Granada, Granada, Spain
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8
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Maciá-Martínez MA, Gil M, Huerta C, Martín-Merino E, Álvarez A, Bryant V, Montero D. Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP): A data resource for pharmacoepidemiology in Spain. Pharmacoepidemiol Drug Saf 2020; 29:1236-1245. [PMID: 32337840 DOI: 10.1002/pds.5006] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) is a population based database administered by the AEMPS (Spanish Agency for Medicines) of longitudinal electronic medical records (EMR) of patients attended in primary care. Its main purpose is to serve as source of information for independent studies on drug safety and support of medicines regulation activities. This article aim is to describe the characteristics of BIFAP, how to access the database and a summary of its potential for research. METHODS Health problems are registered by primary care physicians as episodes of care and include socio-demographic data, results of diagnostic procedures, lifestyle data, general data, and interventions. A proportion of data on hospitalizations and specialist care are currently available through linkage with other data sources. EMRs of the Spanish healthcare system are provided by the regional administrations. Specific data extraction and standardization processes are performed. RESULTS BIFAP includes data from 12 million patients starting in 2001 and updated annually. Validation of drug and diagnosis definitions has been ascertained. Participation in international collaborative projects and a number of articles in peer reviewed journals reflect its contribution to the knowledge of the risks associated with medicines and drug utilization patterns. CONCLUSIONS BIFAP is a useful tool for generating scientific evidence on medicines related issues, helping regulatory decision making in Europe. The main strengths of BIFAP are related to large sample size, population-based, longitudinal nature and annual update of data. BIFAP shares common challenges with similar data sources including accurate and efficient identification of health outcomes and of treatment exposure.
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Affiliation(s)
- Miguel-Angel Maciá-Martínez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Miguel Gil
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Consuelo Huerta
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Elisa Martín-Merino
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Arturo Álvarez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Verónica Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Dolores Montero
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
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- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
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Alqdwah-Fattouh R, Rodríguez-Martín S, de Abajo FJ, González-Bermejo D, Gil M, García-Lledó A, Bolúmar F. Differential effects of antidepressant subgroups on risk of acute myocardial infarction: A nested case-control study. Br J Clin Pharmacol 2020; 86:2040-2050. [PMID: 32250461 DOI: 10.1111/bcp.14299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 01/20/2023] Open
Abstract
The primary objective of this study was to investigate the association between antidepressants use and the risk of acute myocardial infarction (AMI). METHODS We conducted a nested case-control study using a primary care database over the period 2002-2015. From a cohort of patients aged 40-99 years, we identified incident AMI cases and randomly selected 5 controls per case, matched to cases for exact age, sex and index date. Exposure to antidepressants were categorised as current, recent, past and nonusers. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were computed using conditional logistic regression to assess the association between the current use of different antidepressants subgroups and AMI as compared to nonuse. Dose and duration effects were explored. RESULTS Totals of 24 155 incident AMI cases and 120 775 controls were included. The current use of antidepressants as a group was associated with a reduced risk (AOR = 0.86; 95% CI: 0.81-0.91), but mainly driven by selective serotonin reuptake inhibitors (AOR = 0.86; 95% CI:0.81-0.93). A reduced risk was also observed with trazodone (AOR = 0.76;95% CI: 0.64-0.91), and clomipramine (AOR = 0.62; 95% CI: 0.40-0.96), whereas no significant effect was observed with other antidepressants. A duration-dependent effect was suggested for selective serotonin reuptake inhibitors, trazodone and clomipramine, while there was no clear dose-dependency. CONCLUSION This study suggests that current use of antidepressants interfering selectively with the reuptake of serotonin, and those antagonizing the 5-HT2A receptor, are associated with a decrease in AMI risk and should be the antidepressants of choice in patients at cardiovascular risk.
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Affiliation(s)
- Rasha Alqdwah-Fattouh
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Madrid, Spain
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology Sector), School of Medicine, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Diana González-Bermejo
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
| | - Alberto García-Lledó
- Cardiology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Medicine, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Francisco Bolúmar
- Unit of Epidemiology and Public Health. School of Medicine, University of Alcalá, Madrid, Spain.,Department of Epidemiology and Biostatistics. Graduate School of Public Health, City University of New York, New York, NY, USA.,Ciberesp, Spain
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10
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Watt JA, Gomes T, Bronskill SE, Huang A, Austin PC, Ho JM, Straus SE. Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study. CMAJ 2019; 190:E1376-E1383. [PMID: 30478215 DOI: 10.1503/cmaj.180551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Trazodone is increasingly prescribed for behavioural and psychological symptoms of dementia, but little is known about its risk of harm. Our objective was to describe the comparative risk of falls and fractures among older adults with dementia dispensed trazodone or atypical antipsychotics. METHODS The study cohort included adults with dementia (excluding patients with chronic psychotic illnesses) living in long-term care and aged 66 years and older. Data were obtained from routinely collected, linked health administrative databases in Ontario, Canada. We compared new users of trazodone with new users of atypical antipsychotics (quetiapine, olanzapine or risperidone) between Dec. 1, 2009, and Dec. 31, 2015. The primary outcome was a composite of fall or major osteoporotic fracture within 90 days of first prescription. Secondary outcomes were falls, major osteoporotic fractures, hip fractures and all-cause mortality. RESULTS We included 6588 older adults dispensed trazodone and 2875 dispensed an atypical antipsychotic, of whom 95.2% received a low dose of these medications. Compared with use of atypical antipsychotics, use of trazodone was associated with similar rates of falls or major osteoporotic fractures (weighted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.73 to 1.07), major osteoporotic fracture (weighted HR 1.03, 95% CI 0.73 to 1.47), falls (weighted HR 0.91, 95% CI 0.75 to 1.11) and hip fractures (weighted HR 0.92, 95% CI 0.59 to 1.43). Use of trazodone was associated with a lower rate of mortality (weighted HR 0.75, 95% CI 0.66 to 0.85). INTERPRETATION Trazodone is not a uniformly safer alternative to atypical antipsychotics, given the similar risk of falls and fractures among older adults with dementia.
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Affiliation(s)
- Jennifer A Watt
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Tara Gomes
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Susan E Bronskill
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Anjie Huang
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Peter C Austin
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Joanne M Ho
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Sharon E Straus
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont.
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Pirker-Kees A, Dal-Bianco P, Schmidt R. Effects of Psychotropic Medication on Cognition, Caregiver Burden, and Neuropsychiatric Symptoms in Alzheimer’s Disease over 12 Months: Results from a Prospective Registry of Dementia in Austria (PRODEM). J Alzheimers Dis 2019; 71:623-630. [DOI: 10.3233/jad-181102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Agnes Pirker-Kees
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics and Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
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