Department of Pharmacy, Kanazawa Medical University Hospital, Kahoku, Japan.
Medical Safety Division, Kanazawa Medical University Hospital, Kahoku, Japan.
Neuropsychopharmacol Rep. 2022 Dec;42(4):532-537. doi: 10.1002/npr2.12297. Epub 2022 Nov 2.
No consensus has been reached on the association between the risk of falls and antipsychotic and antidepressant drug use. In this study, we evaluated the risk of falls with trazodone, risperidone, and quetiapine, which are recommended for use at Kanazawa Medical University Hospital.
We reviewed all patients who were admitted to Kanazawa Medical University Hospital between January 1st and December 31st, 2018. We excluded those aged <20 years and those admitted to pediatric, intensive care, and psychiatric wards. Finally, 9273 patients were included. We reviewed the incidence in these patients of accidental falls reported to the medical safety department. We noted whether these patients received trazodone, quetiapine, or risperidone. We also observed whether they were taking a benzodiazepine receptor agonist, which is a known risk factor. We further examined each patient's age, sex, the department they were visiting, and their diseases. Patients were considered to have taken medication if it was administered within 24 hours before an accidental fall. Multiple logistic regression analysis was used to evaluate the risk of accidental fall.
Multivariate analysis showed that the adjusted odds ratios (OR) for each medication (with 95% confidence intervals) were: trazodone (OR, 0.47 [0.27-0.80]), quetiapine (OR, 1.06 [0.46-2.46]), and risperidone (OR, 0.82 [0.41-1.63]).
The association of risperidone and quetiapine with accidental falls was unclear. Interestingly, however, trazodone may help reduce the risk, which makes it a potential pharmacologic treatment option for insomnia in patients at high risk for accidental falls.
抗精神病药和抗抑郁药的使用与跌倒风险之间的关联尚未达成共识。在这项研究中，我们评估了在金泽医科大学医院推荐使用的曲唑酮、利培酮和喹硫平与跌倒风险的关系。
我们回顾了 2018 年 1 月 1 日至 12 月 31 日期间入住金泽医科大学医院的所有患者。排除年龄<20 岁和入住儿科、重症监护和精神科病房的患者。最终纳入 9273 例患者。我们回顾了向医疗安全部门报告的意外跌倒事件的发生率。我们注意到这些患者是否接受了曲唑酮、喹硫平或利培酮治疗。我们还观察了他们是否正在服用苯二氮䓬受体激动剂，这是已知的风险因素。我们进一步检查了每位患者的年龄、性别、就诊科室和疾病。如果患者在意外跌倒前 24 小时内使用了药物，则认为其正在服用药物。采用多变量逻辑回归分析评估意外跌倒的风险。
多变量分析显示，每种药物（95%置信区间）的调整后比值比（OR）分别为：曲唑酮（OR，0.47 [0.27-0.80]）、喹硫平（OR，1.06 [0.46-2.46]）和利培酮（OR，0.82 [0.41-1.63]）。
利培酮和喹硫平与意外跌倒的关联尚不清楚。然而，有趣的是，曲唑酮可能有助于降低风险，这使其成为有意外跌倒风险的失眠患者的潜在药物治疗选择。
