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1.
Neuropsychopharmacol Rep ; 42(4): 532-537, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36321609

RESUMO

AIM: No consensus has been reached on the association between the risk of falls and antipsychotic and antidepressant drug use. In this study, we evaluated the risk of falls with trazodone, risperidone, and quetiapine, which are recommended for use at Kanazawa Medical University Hospital. METHODS: We reviewed all patients who were admitted to Kanazawa Medical University Hospital between January 1st and December 31st, 2018. We excluded those aged <20 years and those admitted to pediatric, intensive care, and psychiatric wards. Finally, 9273 patients were included. We reviewed the incidence in these patients of accidental falls reported to the medical safety department. We noted whether these patients received trazodone, quetiapine, or risperidone. We also observed whether they were taking a benzodiazepine receptor agonist, which is a known risk factor. We further examined each patient's age, sex, the department they were visiting, and their diseases. Patients were considered to have taken medication if it was administered within 24 hours before an accidental fall. Multiple logistic regression analysis was used to evaluate the risk of accidental fall. RESULTS: Multivariate analysis showed that the adjusted odds ratios (OR) for each medication (with 95% confidence intervals) were: trazodone (OR, 0.47 [0.27-0.80]), quetiapine (OR, 1.06 [0.46-2.46]), and risperidone (OR, 0.82 [0.41-1.63]). CONCLUSION: The association of risperidone and quetiapine with accidental falls was unclear. Interestingly, however, trazodone may help reduce the risk, which makes it a potential pharmacologic treatment option for insomnia in patients at high risk for accidental falls.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Trazodona , Criança , Humanos , Acidentes por Quedas , Estudos de Casos e Controles , Fumarato de Quetiapina/efeitos adversos , Medição de Risco , Risperidona/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Trazodona/efeitos adversos
2.
BMC Geriatr ; 22(1): 484, 2022 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-35658904

RESUMO

BACKGROUND: Falls are the leading cause of injury-related death among older Americans. While some research has found that insomnia heightens falls, health care resource utilization (HCRU) and costs, the impact of insomnia treatments on fall risk, mortality, HCRU and costs in the elderly population, which could be of substantial interest to payers, has not been fully elucidated. This study evaluated the risk of falls and related consequences among adults ≥ 65 years of age treated with common prescription medications for insomnia compared with non-sleep disordered controls. METHODS: This was a retrospective cohort analysis of deidentified Medicare claims from January 2011 through December 2017. Medicare beneficiaries treated for insomnia receiving zolpidem extended-release, zolpidem immediate-release, trazodone, or benzodiazepines were matched with non-sleep disordered controls. The main outcomes were falls, mortality, healthcare resource utilization (HCRU), and medical costs during the 12 months following the earliest fill date for the insomnia medication of interest. Generalized linear models controlled for several key covariates, including age, race, sex, geographic region and Charlson Comorbidity Index score. RESULTS: The study included 1,699,913 Medicare beneficiaries (59.9% female, mean age 75 years). Relative to controls, adjusted analyses showed that beneficiaries receiving insomnia medication experienced over twice as many falls (odds ratio [OR] = 2.34, 95% CI: 2.31-2.36). In adjusted analyses, patients receiving benzodiazepines or trazodone had the greatest risk. Crude all-cause mortality rates were 15-times as high for the insomnia-treated as controls. Compared with controls, beneficiaries receiving insomnia treatment demonstrated higher estimated adjusted mean number of inpatient, outpatient, and emergency department visits and longer length of inpatient stay. All-cause total adjusted mean costs were higher among insomnia treated patients ($967 vs $454). CONCLUSIONS: Individuals receiving insomnia treatment had an increased risk of falls and mortality and higher HCRU and costs compared with matched beneficiaries without sleep disorders. Trazodone and benzodiazepines were associated with the greatest risk of falls. This analysis suggests that significant risks are associated with common, older generation insomnia medication treatments in the elderly. Nonetheless, these results should be interpreted with caution as the use of these medications may be indicative of underlying morbidity with potential for residual confounding.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Trazodona , Acidentes por Quedas , Idoso , Benzodiazepinas/uso terapêutico , Atenção à Saúde , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Medicare , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Trazodona/efeitos adversos , Estados Unidos/epidemiologia , Zolpidem/efeitos adversos
3.
Adv Ther ; 39(3): 1324-1340, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35072889

RESUMO

INTRODUCTION: Falls are a common cause for morbidity and mortality among patients taking prescription insomnia medication. The objective of this study is to compare the risk of falls, all-cause healthcare resource utilization (HCRU), and costs among patients treated with commonly used, older generation insomnia medications and non-sleep-disordered controls. METHODS: This retrospective cohort study used the IBM® MarketScan® Commercial and Medicare Supplemental Databases to identify patients aged at least 18 years treated with commonly prescribed medications for insomnia (zolpidem, trazodone, benzodiazepines) between 1 January 2012 and 30 September 2017. The insomnia-treated cohort were age- and sex-matched (1:1) to non-sleep-disordered controls. Odds ratios (ORs) compared risk of falls in each cohort, adjusting for covariates. Costs were adjusted to 2018 dollars, the most recent year for the study data. RESULTS: Relative to matched controls (n = 313,086), the insomnia-treated cohort had a higher rate of falls (3.34% vs. 1.33%), and higher risk of falls [OR = 2.36 (95% confidence interval 2.27-2.44)]. Relative to other index treatments, patients treated with trazodone had the greatest risk of falls. Compared with matched controls, the estimated mean number of inpatient visits, emergency department visits, outpatient visits, and mean length of inpatient stay were all significantly higher among patients treated for insomnia. Such patients incurred greater total costs per patient per month than matched controls ($2100 versus $888; estimated mean ratio, 2.36; 95% CI 2.35-2.38; p < 0.0001). CONCLUSIONS: Relative to matched controls, the insomnia-treated cohort showed higher risk of falls with greater HCRU and costs. Each outcome measured was highest among patients treated with trazodone, relative to other index treatments. Findings suggest the need for new treatment options to optimize quality of care for patients with insomnia.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Trazodona , Adolescente , Adulto , Idoso , Benzodiazepinas/efeitos adversos , Estudos de Coortes , Custos de Cuidados de Saúde , Humanos , Medicare , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Trazodona/efeitos adversos , Estados Unidos/epidemiologia , Zolpidem/uso terapêutico
4.
Braz. J. Pharm. Sci. (Online) ; 58: e19256, 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1374553

RESUMO

Abstract Neuropathic pain is generally characterised by an abnormal sensation (dysesthesia), an increased response to painful stimuli (hyperalgesia), and pain in response to a stimulus that does not normally provoke pain (allodynia). The present study was designed to investigate the effect of trazodone (5mg/kg and 10mg/kg) on peripheral neuropathic pain induced by partial sciatic nerve ligation in rats. Mechanical hyperalgesia, cold allodynia and thermal hyperalgesia were assessed by performing the pinprick, acetone, and hot plate tests, respectively. Biochemically, lipid peroxidation level and total calcium levels were measured. However, trazodone administration (5 and 10 mg/ kg i.p.) for 21days significantly diminished partial sciatic nerve ligation-induced neuropathic pain along with areduction in oxidative stress and calcium levels. The results of the present study suggest that trazodone is effective in attenuating partial sciatic nerve ligation-inducedpainful neuropathic states, which may be attributed to decreased oxidative stress and calcium levels.


Assuntos
Animais , Masculino , Ratos , Dor/classificação , Trazodona/análise , Trazodona/efeitos adversos , Hiperalgesia/classificação , Organização e Administração , Nervo Isquiático/fisiopatologia
5.
Urology ; 156: 169-172, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33992665

RESUMO

OBJECTIVES: To review medical malpractice trends and to identify the most common claims filed against medical providers for the management of patients with priapism. METHODS: Using the Westlaw legal database, a search was done for the keyword "priapism" between July 1, 1980 and July 1, 2020. Cases were evaluated for plaintiff demographics, reasons for filing claims, management outcomes, legal verdicts and awards and further categorized based upon the timing of the alleged malpractice. RESULTS: Alleged negligence during the pre-management period was cited in 30 cases. Administration of psychotropic medications was the most common reasons for filing pre-management claims 22/56 (39.3%). Delay in care accounted for 18/56 (32.1%) and complications of surgery were 5/56 (8.9%) of claims. The majority of the completed cases were in favor of the defendants (39/47; 83.0%). There was no association between type of health care provider or timing of alleged malpractice and ultimate verdict. CONCLUSIONS: Prescribing psychoactive medications without warning of the adverse effect profile is the most common reason for claims filed against providers with trazodone as the leading medication. Medical providers should ensure that patients are well informed of this adverse effect prior to prescription. Regardless, the majority of medical malpractice cases carry a verdict in favor of the defendant.


Assuntos
Disfunção Erétil , Imperícia , Priapismo , Psicotrópicos , Disfunção Erétil/epidemiologia , Disfunção Erétil/terapia , Humanos , Revisão da Utilização de Seguros , Masculino , Imperícia/legislação & jurisprudência , Imperícia/tendências , Priapismo/epidemiologia , Priapismo/terapia , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos , Trazodona/administração & dosagem , Trazodona/efeitos adversos , Estados Unidos
6.
Clin J Am Soc Nephrol ; 16(1): 88-97, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33355192

RESUMO

BACKGROUND AND OBJECTIVES: Zolpidem, a nonbenzodiazepine hypnotic, and trazodone, a sedating antidepressant, are the most common medications used to treat insomnia in the United States. Both drugs have side effect profiles (e.g., drowsiness, dizziness, and cognitive and motor impairment) that can heighten the risk of falls and fractures. Despite widespread zolpidem and trazodone use, little is known about the comparative safety of these medications in patients receiving hemodialysis, a vulnerable population with an exceedingly high fracture rate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using data from the United States Renal Data System registry (2013-2016), we conducted a retrospective cohort study to investigate the association between the initiation of zolpidem versus trazodone therapy and the 30-day risk of hospitalized fall-related fractures among Medicare-enrolled patients receiving maintenance hemodialysis. We used an active comparator new-user design and estimated 30-day inverse probability of treatment-weighted hazard ratios and risk differences. We treated death as a competing event. RESULTS: A total of 31,055 patients were included: 18,941 zolpidem initiators (61%) and 12,114 trazodone initiators (39%). During the 30-day follow-up period, 101 fall-related fractures occurred. Zolpidem versus trazodone initiation was associated with a higher risk of hospitalized fall-related fracture (weighted hazard ratio, 1.71; 95% confidence interval, 1.11 to 2.63; weighted risk difference, 0.17%; 95% confidence interval, 0.07% to 0.29%). This association was more pronounced among individuals prescribed higher zolpidem doses (hazard ratio, 1.85; 95% confidence interval, 1.10 to 3.01; and risk difference, 0.20%; 95% confidence interval, 0.04% to 0.38% for higher-dose zolpidem versus trazodone; and hazard ratio, 1.60; 95% confidence interval, 1.01 to 2.55 and risk difference, 0.14%; 95% confidence interval, 0.03% to 0.27% for lower-dose zolpidem versus trazodone). Sensitivity analyses using longer follow-up durations yielded similar results. CONCLUSIONS: Among individuals receiving maintenance hemodialysis, zolpidem initiators had a higher risk of hospitalized fall-related fracture compared with trazodone initiators. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_12_18_CJN10070620_final.mp3.


Assuntos
Fraturas Ósseas/epidemiologia , Insuficiência Renal Crônica/terapia , Medicamentos Indutores do Sono/efeitos adversos , Trazodona/efeitos adversos , Zolpidem/efeitos adversos , Acidentes por Quedas/estatística & dados numéricos , Idoso , Disfunção Cognitiva/induzido quimicamente , Tontura/induzido quimicamente , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Sistema de Registros , Diálise Renal , Estudos Retrospectivos , Medicamentos Indutores do Sono/administração & dosagem , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Estados Unidos/epidemiologia , Zolpidem/administração & dosagem
7.
J Ayub Med Coll Abbottabad ; 22(3): 94-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-22338428

RESUMO

BACKGROUND: Major depressive disorder is a serious and disabling illness in the world and is common chronic and recurrent disorder. It is the fourth most important cause of worldwide loss in disability. METHODS: This was prospective and open-label study, study conducted in JPMC. Karachi, to evaluate the efficacy and adverse effects in major depressive disorder individuals. A total of 40 patients irrespective of the gender, aged 18 years up to 65 years were enrolled from OPD of Psychiatry Department. Follow-up visits were carried out fortnightly after making evaluation of symptoms at baseline visit (day 0), follow-up continued till 90 days when the results were compiled. RESULTS: Statistically significant (p < 0.05) results were observed in all the parameters at the end of study, i.e., day 90. CONCLUSION: Among all the symptoms of major depressive disorder, trazodone proved to be more effective in controlling insomnia.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Trazodona/uso terapêutico , Adolescente , Adulto , Idoso , Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Trazodona/efeitos adversos , Resultado do Tratamento
8.
Ann Pharmacother ; 38(7-8): 1197-201, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15150381

RESUMO

OBJECTIVE: To assess the probability of cerebrovascular adverse drug reactions (CV-ADRs) due to treatment with selective serotonin-reuptake inhibitors (SSRIs) using 2 causality methods. case summaries: Two patients with the possibility of SSRI-related stroke were referred for causality assessment. Causality assessment was performed using an adverse drug reaction probability scale, as well as clinical and radiologic parameters. A 31-year-old white man, who had been receiving paroxetine 200 mg/day over a period of 3 years, developed ischemic stroke involving left middle cerebral artery. The second patient was a 46-year-old white woman with a history of recurrent depression who developed delirium and ischemic stroke while she was taking a combination of paroxetine 50 mg/day, trazodone 200 mg/day, and bupropion 150 mg/day. DISCUSSION: Carotid and cardiothromboembolism were found to be the major etiological factors for ischemic stroke. Accounting for the temporal relation, prior reports of SSRI treatment-associated CV-ADRs, and the pharmacologic action of serotonin on coagulation and the vascular system, the possible contribution of SSRIs to stroke in these patients was considered. An objective causality assessment using the Naranjo probability scale revealed that a CV-ADR was possible. However, the nature of the stroke, plus clinical and radiologic findings, were inconsistent with known pathophysiologic mechanisms linking SSRIs and stroke in these patients. CONCLUSIONS: Causality assessment may improve unbiased recognition, management, and voluntary reporting of infrequent adverse effects such as SSRI treatment-related cerebrovascular accident.


Assuntos
Paroxetina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Trazodona/efeitos adversos , Adulto , Bupropiona/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Inibidores da Captação de Dopamina/uso terapêutico , Quimioterapia Combinada , Transtorno Distímico/complicações , Transtorno Distímico/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Paroxetina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Trazodona/uso terapêutico
9.
Psychiatr Serv ; 48(11): 1420-6, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9355169

RESUMO

OBJECTIVE: Four groups of patients receiving different antidepressant drugs in a primary care setting were compared in terms of duration of antidepressant therapy and health and mental health care utilization and costs. METHODS: A retrospective analysis of the medical and pharmacy claims of an employed population and their families was conducted. A total of 1,242 patients with a diagnosis of depression were included in the analyses. The four antidepressant cohorts were fluoxetine (N = 799), trazodone (N = 89), the tricyclics amitriptyline and imipramine (N = 104), and the secondary amine tricyclics desipramine and nortriptyline (N = 250). The primary outcome measures were total health care charges, total charges for mental health services, and the pattern of antidepressant use. Secondary measures included charges for outpatient care and pharmacy and the number of outpatient visits. Data analysis involved use of two-stage multivariate regression modeling known as sample selection models. RESULTS: Patients taking fluoxetine achieved higher rates of continuous use for at least six months compared with those taking the other drugs. After selection bias due to observed and unobserved characteristics and other confounding variables was adjusted for, no significant differences were found between drug cohorts in total medical charges. CONCLUSIONS: Improvements in the process of care at no apparent increase in total charges appear possible through appropriate medication therapy.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Mau Uso de Serviços de Saúde/economia , Serviços de Saúde Mental/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Antidepressivos/efeitos adversos , Antidepressivos/economia , Antidepressivos Tricíclicos/efeitos adversos , Antidepressivos Tricíclicos/economia , Antidepressivos Tricíclicos/uso terapêutico , Estudos de Coortes , Transtorno Depressivo/economia , Transtorno Depressivo/psicologia , Custos de Medicamentos/estatística & dados numéricos , Honorários Médicos/estatística & dados numéricos , Feminino , Fluoxetina/efeitos adversos , Fluoxetina/economia , Fluoxetina/uso terapêutico , Humanos , Masculino , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Trazodona/efeitos adversos , Trazodona/economia , Trazodona/uso terapêutico , Estados Unidos
10.
Clin Pharm ; 1(5): 406-17, 1982.
Artigo em Inglês | MEDLINE | ID: mdl-6764164

RESUMO

The chemistry, pharmacokinetics, biochemistry and pharmacology, clinical trials, adverse effects, FDA-approved indications, and availability and cost of trazodone hydrochloride, a triazolopyridine antidepressant, are reviewed. Trazodone is nearly completely absorbed after oral administration; although food delays absorption and reduces peak serum concentration, total area under the plasma concentration-time curve is not altered. Trazodone has biphasic elimination, with a redistribution half-life of about one hour and an elimination half-life of 10-12 hours. Trazodone is nearly completely metabolized hepatically by hydroxylation and oxidation to metabolites that are probably inactive. Trazodone is less potent but more selective than conventional tricyclic antidepressants; at low doses, trazodone acts as a serotonin antagonist, while at high doses it acts as a serotonin agonist. Trazodone has been compared with imipramine, amitriptyline, desipramine, and placebo in controlled clinical trials and found to be an effective antidepressant. Trazodone causes significantly fewer anticholinergic side effects than does imipramine. Trazodone has few cardiovascular side effects. In patients ingesting toxic amounts of trazodone, no deaths have been reported unless other drugs were present or ingested concomitantly. The usual adult daily dose of trazodone hydrochloride is 150-400 mg given in two divided doses. Trazodone is an effective antidepressant with a low incidence of serious adverse effects. It may be particularly useful in certain depressed patients who are intolerant of anticholinergic effects of other antidepressants, have cardiac conduction disturbances, or who do not respond to treatment with tricyclic antidepressants and in whom electroshock therapy is contraindicted.


Assuntos
Antidepressivos , Piperazinas/farmacologia , Trazodona/farmacologia , Animais , Sistema Nervoso Autônomo/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Gatos , Fenômenos Químicos , Química , Ensaios Clínicos como Assunto , Custos e Análise de Custo , Transtorno Depressivo/tratamento farmacológico , Cães , Método Duplo-Cego , Interações Medicamentosas , Coração/efeitos dos fármacos , Humanos , Cinética , Trazodona/administração & dosagem , Trazodona/efeitos adversos , Trazodona/metabolismo , Trazodona/uso terapêutico
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