Role of community pharmacists in the detection of potentially inappropriate benzodiazepines prescriptions for insomnia
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Background The appropriate management of chronic insomnia is crucial and prescribing of hypnotic drugs is common. Regular and prolonged use of hypnotics should be avoided because of the risk of tolerance to effects, dependence and an increased risk of adverse events. In 2012, updated Beers criteria for potentially inappropriate medication in older adults suggested to avoid all benzodiazepines in older adults to treat insomnia. In addition, successful discontinuation may result in improvements on cognitive and psychomotor function, particularly in older people. Objective To investigate the appropriateness of benzodiazepines prescription for insomnia and explore the role that community pharmacists can have in identifying signals of potential inappropriate drug prescriptions. Setting Community pharmacies in Italy. Method This is an observational study conducted in 8 community pharmacies. Each pharmacist was asked to interview a sample of patients with the prescriptions of at least one benzodiazepine and to complete a minimum data set collecting information about socio-demographic characteristics, drug indication, duration of drug prescription, number of hypnotic-drugs, previous attempt to drug-discontinuation, preference of patients about benzodiazepine withdrawal and modality of drug tapering. Main outcome measure Indications, treatment duration, dosage and drug discontinuation attempts and modalities. Results A total of 181 participants were interviewed. About half of respondents (n = 81) reported to be treated for insomnia and 62 % were elderly (mean age 68, range 27–93). Fifty-two patients (64 %) were on long term treatment (>3 years) while for thirteen patients (16 %) duration of treatment was comprised between 1 and 3 years. Thirty-three patients were in favour of benzodiazepine-discontinuation but in all cases discontinuation was unsuccessful. Conclusion Use of community pharmacy survey data allowed us to obtain information about incorrect management of insomnia and inappropriate benzodiazepines prescriptions. Stricter adherence to evidence-based guidelines is essential for a rational use of hypnotic and sedatives.
KeywordsBenzodiazepines Community pharmacies Elderly Insomnia Italy Medication appropriateness Pharmacoepidemiology
The authors would like to thank the patients who took part to the study. We are grateful to all community pharmacists of SGCP for data collection: Clementina Nucci, Gaspare Ganduscio, Francesco Spanò, Mauro Lussu, Valentina Santandrea, Santina Clericò, Marco Fortini, Francesco Gamaleri.
The study was voluntary, without any financial support. Sponsor’s role: none.
Conflicts of interest
The authors declare that there is no conflict of interest.
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