RESUMEN
BACKGROUND: Benzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care. METHODS: This is a cross-sectional analytical study, using dispensing records of diazepam, clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized. FINDINGS: A total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use. CONCLUSIONS: These results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings.
Asunto(s)
Benzodiazepinas , Prescripción Inadecuada , Atención Primaria de Salud , Humanos , Masculino , Femenino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Benzodiazepinas/uso terapéutico , Benzodiazepinas/efectos adversos , Benzodiazepinas/administración & dosificación , Prescripción Inadecuada/estadística & datos numéricos , Estudios Transversales , Anciano , Brasil , Adulto , Diazepam/uso terapéutico , Diazepam/efectos adversos , Diazepam/administración & dosificación , Nitrazepam/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Clonazepam/uso terapéutico , Clonazepam/efectos adversos , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiologíaRESUMEN
El objetivo de este estudio fue caracterizar la prescripción de los medicamentos ansiolíticos utilizados en población de adultos mayores institucionalizados en el hogar de ancianos de Pinar del Río durante el año 2017.Se realizó un estudio descriptivo transversal, con recogida de datos retrospectiva, sobre prescripción de medicamentos ansiolíticos en la población de adultos mayores institucionalizados en el hogar de ancianos, se analizó la forma de utilización de los medicamentos, su indicación y prescripción con elementos de esquema terapéutico y factores que condicionan los hábitos de prescripción. Se trabajó con el universo (U= 98) de estudio el cual estuvo conformado por el total de pacientes institucionalizados, que estaban consumiendo ansiolíticos. Se revisaron las historias clínicas individuales y se confeccionó un modelo de recolección de datos.El medicamento más consumido por los adultos mayores fue el nitrazepam (41,8 %), siendo este a su vez el más consumido por el sexo masculino, no así para el femenino que resultó ser el clorodiazepóxido (64,6 %), el grupo de edad que más predominó fue el de 60-69 años, asimismo los viudos y el nivel educacional primario, el 79,5 % de los ancianos consume otros medicamentos que poseen interacción farmacocinética. El profesional que más indicó fue el médico de familia, la prescripción e intervalos entre dosis fue adecuada, la prescripción se consideró no racional.La prescripción de ansiolíticos en la población objeto de estudio, disminuye a medida que aumenta la edad, los más consumidores son los del sexo masculino y los institucionalizados por abandono familiar, esto apunta a la necesidad de continuar trabajando desde el nivel primario de atención dado que es de donde proceden estos ancianos.
The objective of this study was to characterize the prescription of anxiolytic medications used in the institutionalized elderly population at the Pinar del Río Nursing Home during 2017.A cross-sectional descriptive study was carried out, with retrospective data collection, on the prescription of anxiolytic medications in the population of institutionalized older adults in the Nursing Home, the form of use of the medications, their indication and prescription with elements of the therapeutic scheme was analyzed and factors that condition prescription habits. We worked with the universe (U = 98) of the study, which was made up of the total number of institutionalized patients who were consuming anxiolytics. Individual medical records were reviewed and a data collection model was created.The drug most consumed by older adults was nitrazepam (41.8%), this in turn being the most consumed by males, not so for females, which turned out to be chlorodiazepoxide (64.6%), the group The most prevalent age group was 60-69 years, likewise widowers and primary educational level, 79.5% of the elderly consume other drugs that have pharmacokinetic interaction. The professional who indicated the most was the family doctor, the prescription and intervals between doses were adequate, the prescription was considered non-rational.The prescription of anxiolytics in the population under study decreases as age increases, the most consumers are those of the male sex and those institutionalized due to family abandonment, this points to the need to continue working from the primary level of care since that is where these elders come from.
Asunto(s)
Anciano , Anciano de 80 o más Años , Prescripciones de Medicamentos , Ansiolíticos/uso terapéutico , Clordiazepóxido/uso terapéutico , Hogares para Ancianos , Nitrazepam/uso terapéutico , Casas de Salud , Epidemiología Descriptiva , Estudios Transversales , Estudios Retrospectivos , Distribución por Sexo , Distribución por EdadRESUMEN
In a retrospective study we assessed the outcome of the criptogenic and symptomatic forms of West syndrome and evaluated the efficacy of adrenocorticotropic hormone, vigabatrin, prednisone, valproate and nitrazepam in the spasms control. Seventy patients were follwed up by 2 years. Twelve (17%) were criptogenics and 58 (83%) symptomatics. In criptogenic group significantly more patients were in regular school classes and with normal motor development, better control of seizure, less tendency to evoluate to Lennox Gastaut syndrome and 83. 3% had control of spasms (72.4% of patients from symptomatic group had control of spasms). Adrenocorticotropic hormone and vigabatrin were the most efective drugs, with 68.75% and 60% of spasms control, respectivelly, when used as first line of therapy and 75% and 50%, respectivelly, as second line of therapy.
Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Anticonvulsivantes/uso terapéutico , Glucocorticoides/uso terapéutico , Prednisona/uso terapéutico , Espasmos Infantiles/tratamiento farmacológico , Adolescente , Adulto , Niño , Preescolar , Electroencefalografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nitrazepam/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Ácido Valproico/uso terapéutico , Vigabatrin/uso terapéuticoRESUMEN
Em estudo retrospectivo avaliamos a evoluçao clínica e eletrencefalográfica das formas criptogênica e sintomática da síndrome de West e analisamos a eficácia do hormônio adrenocorticotrófico, vigabatrina, prednisona, ácido valpróico e nitrazepam no controle dos espasmos. Participaram do estudo 70 pacientes, acompanhados por período maior que 2 anos. Doze (17 por cento) eram criptogênicos e 58 (83 por cento) sintomáticos. O grupo criptogênico apresentou percentagem significativamente maior de pacientes que frequentavam escola regular e desenvolvimento motor normal, melhor controle das crises epilépticas, tendência menor a evoluir para síndrome de Lennox Gastaut e 83,3 por cento tiveram controle completo dos espasmos (72,4 por cento dos pacientes do grupo sintomático obtiveram controle completo dos espasmos). O hormônio adrenocorticotrófico e a vigabatrina foram as drogas mais eficazes, controlando 68,75 por cento e 60 por cento dos espasmos, respectivamente, quando utilizados como droga de primeira escolha e 75 por cento e 50 por cento, respectivamente, como drogas de segunda escolha
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Hormona Adrenocorticotrópica/uso terapéutico , Anticonvulsivantes/uso terapéutico , Glucocorticoides/uso terapéutico , Prednisona/uso terapéutico , Espasmos Infantiles/tratamiento farmacológico , Electroencefalografía , Estudios de Seguimiento , Nitrazepam/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Ácido Valproico/uso terapéutico , Vigabatrin/uso terapéuticoAsunto(s)
Humanos , Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Hormona Adrenocorticotrópica/uso terapéutico , Carbamazepina/uso terapéutico , Clonazepam/uso terapéutico , Etosuximida/uso terapéutico , Fenitoína/uso terapéutico , Nitrazepam/uso terapéutico , Fenobarbital/uso terapéutico , Primidona/uso terapéutico , Ácido Valproico/uso terapéuticoRESUMEN
Mogadon as a parenteral solution was employed for treating status epilepticus (15 cases), intermitent epileptic seizures (10 cases), Lennox syndrome (14 cases), myoclonic seizures (5 cases) and absences (6 cases). The dosage layed between 3,3 mg and 10 mg according to each individual case. Status epilepticus and intermitent seizures disappeared following the injection and so did the irritative EEG alterations. Remission was observed in 10 Lennox cases while the remaining 4 improved. Mogadon abolished myoclonic seizures, in some cases beyond 6 hours. In simple absence improvement was also evident, although more shortlived than in myoclonic seizures. Sleepiness was side-effect, occurring in some cases.
Asunto(s)
Epilepsia/tratamiento farmacológico , Nitrazepam/uso terapéutico , Electroencefalografía , Epilepsias Mioclónicas/tratamiento farmacológico , Epilepsias Parciales/tratamiento farmacológico , Epilepsia Tipo Ausencia/tratamiento farmacológico , Femenino , Humanos , Infusiones Parenterales , Masculino , Nitrazepam/administración & dosificación , Nitrazepam/farmacología , Estado Epiléptico/tratamiento farmacológicoRESUMEN
The electroencephalographic findings observed in twenty-nine patients with Lennox-Gastaut syndrome were related with prognosis of the epileptic manifestations. The presence of slow spike-wave complexes with preponderance of spike over the slow wave and the presence of fixed complexes in spite of the medical treatment, are related with poor prognosis for the epileptic manifestations.
Asunto(s)
Electroencefalografía , Epilepsia Tipo Ausencia/diagnóstico , Hormona Adrenocorticotrópica/uso terapéutico , Niño , Preescolar , Clonazepam/uso terapéutico , Epilepsia Tipo Ausencia/tratamiento farmacológico , Femenino , Humanos , Lactante , Masculino , Nitrazepam/uso terapéutico , PronósticoRESUMEN
The therapeutics results with the use of different drugs (diazepam, nitrazepam, clonazepam, diphenylhydantoin, barbiturates--phenobarbital and primidone--, sodium dipropylacetate and ACTH) in twenty-nine patients with Lennox--Gastaut syndrome are carefully analysed. The effect of each drug on seizures (tonic, tonic-clonic, clonic, myoclonic or myoclonic-atonic, atonic and atypical absences) during the first month of each treatment is discussed. The "specific" use of each drug on the various forms of epileptic seizures is determined and the possibility of crisis control with reduction of the drugs dosage is verified.