OnMedica – News – The risk of falling with trazodone is as high as antipsychotic treatment

Trazodone presents a risk similar to that of antipsychotics for falls and major fractures in elderly people with dementia

According to a new study *, elderly people with dementia taking trazodone are at risk of falling or major fractures as well as antipsychotics. The commentators of the study, published in the Journal of the Canadian Medical Association, noted ** that there is currently no safe drug option for the treatment of the behavioral and psychological symptoms of dementia; therefore, the prescription of psychotropic drugs for these symptoms should follow the principle of geriatric medicine "Start slowly and go slowly".

The research team, from the University of Toronto in Canada, pointed out that, although trazodone is increasingly prescribed to treat the behavioral and psychological symptoms of dementia, its risk of harm is poorly understood. They conducted a retrospective cohort study, using data routinely collected from administrative health databases in Ontario, to badess the comparative risk of falls and fractures in older adults with trzodone provided by Ontario. dementia or atypical antipsychotics.

They compared the composite risk of falling or major osteoporotic fracture within 90 days of the first prescription among 6,588 seniors with trazodone and 2,875 with atypical antipsychotic medication (quetiapine, olanzapine or risperidone), 95 2% received a low dose of these drugs; They also compared falls, major osteoporotic fractures, hip fractures and all-cause mortality among the groups.

The researchers reported that, compared to atypical antipsychotics, trazodone patients had statistically significant rates of major osteoporotic falls or fractures HR 0.92). However, the use of trazodone was badociated with a significantly lower all-cause mortality rate (HR 0.75).

They concluded, "While clinicians seek to reduce the use of antipsychotics, we should not consider trazodone as a uniformly safer alternative to atypical antipsychotics because the use of trazodone was badociated with a comparable risk of falls and major osteoporotic fractures to atypical antipsychotics – drugs badociated with these drugs results in our patient population. "

The authors of an badociated commentary stated that it was important to emphasize non-pharmacological approaches for the management of behavioral and psychological symptoms of dementia; and prescribers to weigh the potential benefits of pharmacological treatment against potential harms and to obtain the informed consent obtained from the person with dementia or his or her substitute decision-maker.

They added that psychotropic drugs can play a useful role in managing the behavioral and psychological symptoms of dementia (for example, in situations where the safety of the person with dementia or another person is threatened) , but they said: "The prescription of psychotropic drugs for behavioral purposes and the psychological symptoms of dementia should follow the principle of geriatric medicine of" start low and go slowly "; that is, clinicians should prescribe short-term treatment, carefully monitor the symptoms and behavior, as well as the adverse effects of the drugs. "

* Watt JA, Gomes T, Bronskill SE, et al. Comparative risk of harm badociated with the use of trazodone or an atypical antipsychotic in elderly people with dementia: retrospective cohort study. CMAJ November 26, 2018 190 (47) E1376-E1383; DOI: 10.1503 / cmaj.180551.

** Abi-Jaoude E, Stall NM, Rochon PA. Psychotropic Drugs for the Behavioral and Psychological Symptoms of Dementia: No Free Conduct. CMAJ November 26, 2018 190 (47) E1374-E1375; DOI: 10.1503 / cmaj.181486.