Urru Silvana Anna Maria, Pasina Luca, Minghetti Paola, Giua Corrado
Biomedicine Sector, CRS4 Science and Technology Park Polaris, Piscina Manna, 09010, Pula, CA, Italy.
IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Int J Clin Pharm. 2015 Dec;37(6):1004-8. doi: 10.1007/s11096-015-0166-4. Epub 2015 Jul 22.
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.
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.
Community pharmacies in Italy.
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.
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.
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.
慢性失眠的恰当管理至关重要，开具催眠药物很常见。由于存在对药物效果产生耐受性、依赖以及不良事件风险增加的问题，应避免长期规律使用催眠药。2012年，更新后的老年人潜在不适当用药的Beers标准建议老年人避免使用所有苯二氮䓬类药物治疗失眠。此外，成功停药可能会改善认知和精神运动功能，尤其是在老年人中。
调查苯二氮䓬类药物用于失眠治疗的合理性，并探讨社区药剂师在识别潜在不适当药物处方信号方面可发挥的作用。
意大利的社区药房。
这是一项在8家社区药房进行的观察性研究。要求每位药剂师访谈至少开具了一种苯二氮䓬类药物处方的患者样本，并完成一个最小数据集，收集有关社会人口学特征、药物适应证、药物处方时长、催眠药物数量、既往停药尝试、患者对苯二氮䓬类药物撤药的偏好以及药物逐渐减量方式的信息。主要结局指标为适应证、治疗时长、剂量以及停药尝试和方式。
共访谈了181名参与者。约一半的受访者（n = 81）报告正在接受失眠治疗，62%为老年人（平均年龄68岁，范围27 - 93岁）。52名患者（64%）正在接受长期治疗（>3年），而13名患者（16%）的治疗时长在1至3年之间。33名患者赞成停用苯二氮䓬类药物，但所有情况下停药均未成功。
利用社区药房调查数据使我们能够获取有关失眠管理不当和苯二氮䓬类药物处方不适当的信息。更严格地遵循循证指南对于合理使用催眠药和镇静药至关重要。
