Atypical antipsychotics were used previously for treating seniors with dementia. Later, an antidepressant named trazodone was identified as a safer alternative. But, now trazodone was found to have the same incidence of falls and fractures like atypical antipsychotics, according to new research published in CMAJ (Canadian Medical Association Journal).
"As clinicians move to decrease antipsychotic use, we should not consider trazodone as a uniformly safer alternative to atypical antipsychotics, because trazodone use was associated with a comparable risk of falls and major osteoporotic fractures to atypical antipsychotics--drugs associated with these adverse outcomes in our patient population," writes Dr. Jennifer Watt, St. Michael's Hospital, Toronto, Ontario, with coauthors.
‘Elderly patients are advised to follow non-pharmacological measures like behavioral, environmental and caregiver-supportive therapies, which have a much greater effect than psychotropic drug therapies.’
The rate of dementia in Canada is 7%, but it approaches almost 25% in people older than age 85. In long-term care facilities, 62% of residents have dementia, and many exhibit aggressive behaviour. Although evidence is limited on efficacy, antipsychotics and trazodone, an antidepressant also used for sleep issues, are commonly prescribed for patients with dementia.
Using linked data from ICES, researchers looked at data on 6588 seniors newly dispensed trazodone and 2875 newly dispensed an atypical antipsychotic. They found that patients dispensed trazodone had a rate of falls and major fractures, including hip fractures, similar to that of the group receiving atypical antipsychotics. However, trazodone was associated with a lower risk of death in these patients.
"We hope this information can be used to inform conversations that patients and caregivers are having with clinicians about the benefits and risks of different treatment options," says Dr. Watt.
"Watt and colleagues also underscore the importance of prioritizing nonpharmacological approaches for the management of behavioural and psychological symptoms of dementia," writes Dr. Elia Abi-Jaoude, The Hospital for Sick Children (SickKids) and University Health Network, Toronto, Ontario, with coauthors in a related commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181486.
"Nonpharmacological approaches comprise a variety of behavioural, environmental and caregiver-supportive interventions, and existing evidence suggests that these show a greater effect than many psychotropic drug therapies."
"Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study" is published.