Gomes Samuel, Broeiro-Gonçalves Paula, Meireles Cristina, Caldeira Daniel, Costa João, Guerreiro Mara Pereira, Ribeiro Nadine, Afonso Renata
Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa; Unidade de Saúde Familiar Águas Livres. Amadora. Portugal.
Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo; Unidade de Cuidados de Saúde Primários dos Olivais; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal.
Acta Med Port. 2023 Apr 3;36(4):264-274. doi: 10.20344/amp.18680.
Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region.
From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration.
There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator "proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics", was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator "proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics", the median was 93.6 in 2019 and 94.3 in 2020.
There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.
在经济合作与发展组织成员国中，葡萄牙报告的抗焦虑药、催眠药和镇静剂消费量最高，其中很大一部分是苯二氮䓬类药物或相关药物。已知这些药物会导致耐受性和依赖性。一些报告已确定其他具有催眠作用的药物，如抗抑郁药、抗组胺药、抗精神病药或抗惊厥药，可作为苯二氮䓬类药物治疗失眠的替代品。在这方面，本研究的目的是描述苯二氮䓬类药物、非苯二氮䓬类抗焦虑、催眠或镇静作用药物以及其他有潜在非标签用途治疗失眠的药物的消费情况，以及里斯本和塔霍河谷地区初级卫生保健机构中与苯二氮䓬类药物消费相关指标的结果。
2013年至2020年，进行了一项普查、描述性和回顾性研究。对变量总限定日剂量、每千居民每日限定日剂量（DHD）及相关指标的变化情况进行了描述。数据从里斯本和塔霍河谷地区卫生管理部门使用的SIARS平台提取。
苯二氮䓬类药物的消费量有所下降（从57.44降至63.11 DHD），非苯二氮䓬类药物和有潜在非标签用途药物的消费量有所增加（分别从6.56增至8.56 DHD和从14.70增至25.95 DHD）。在非苯二氮䓬类药物中，唑吡坦是消费最多的药物，也呈上升趋势（从4.86增至6.96 DHD）。对于有潜在非标签用途的药物组，曲唑酮（从3.81增至7.92 DHD）、米氮平（从3.52增至6.48 DHD）、普瑞巴林（从3.15增至4.87 DHD）、喹硫平（从2.68增至4.59 DHD）和加巴喷丁（从1.32增至1.90 DHD）的消费量增加，且仅低剂量制剂出现这种情况（或至少更显著）。初级卫生保健机构指标“无镇静剂、抗焦虑药和催眠药处方的老年患者比例”的中位数在2015年为81.0，2020年增至84.9。对于指标“无镇静剂、抗焦虑药和催眠药长期处方的患者比例”，中位数在2019年为93.6，2020年为94.3。
总体而言，里斯本和塔霍河谷地区苯二氮䓬类药物的配药呈下降趋势。尽管这些数据表明失眠治疗模式有所变化，但仍需要更有力的研究来证实这一观察结果。
