Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 1004–1008 | Cite as

Role of community pharmacists in the detection of potentially inappropriate benzodiazepines prescriptions for insomnia

  • Silvana Anna Maria UrruEmail author
  • Luca Pasina
  • Paola Minghetti
  • Corrado Giua
Short Research Report

Abstract

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.

Keywords

Benzodiazepines Community pharmacies Elderly Insomnia Italy Medication appropriateness Pharmacoepidemiology 

Notes

Acknowledgments

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.

Funding

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.

Supplementary material

11096_2015_166_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)

References

  1. 1.
    National Institutes of Health State of the Science. Conference statement on Manifestations and Management of Chronic Insomnia in Adults. Sleep. 2005;28:1049–57.Google Scholar
  2. 2.
    Saddichha S. Diagnosis and treatment of chronic insomnia. Ann Indian Acad Neurol. 2010;13(2):94–102.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA. 1994;272(4):292–6.CrossRefPubMedGoogle Scholar
  5. 5.
    American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;6(4):616–31.Google Scholar
  6. 6.
    Marcum ZA, Hanlon JT. Commentary on the new American Geriatric Society Beers criteria for potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother. 2012;10(2):151–9.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Pasina L, Urru SAM, Giua C, Minghetti P. Role of community pharmacies for the detection of potentially inappropriate xanthine oxidase inhibitor prescriptions. Drugs: Real World Outcomes. 2015;2:81–6.Google Scholar
  8. 8.
    Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331:1169.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    British National Formulary. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2009. ISBN: 978-0-85369-848-7.Google Scholar
  10. 10.
    Parr JM, Kavanagh DJ, Cahill L, Mitchell G, McD Young R. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction. 2009;104(1):13–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ. 2001;323:1340–3.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Silvana Anna Maria Urru
    • 1
    Email author
  • Luca Pasina
    • 2
  • Paola Minghetti
    • 3
  • Corrado Giua
    • 4
  1. 1.Biomedicine SectorCRS4 Science and Technology Park PolarisPulaItaly
  2. 2.IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
  3. 3.Department of Pharmaceutical SciencesUniversità degli Studi di MilanoMilanItaly
  4. 4.Dipartimento Scienze della VitaUniversità degli Studi di TriesteTriesteItaly

Personalised recommendations