Trazadone linked to risk of falls in elderly with dementia

Trazadone, which is often used as an alternative drug to decrease antipsychotic use is also associated with similar risk of falls and major fractures as antipsychotics in seniors with dementia, according to new research in CMAJ (Canadian Medical Association Journal) reported online published November 26, 2018. Patients who were given trazadone had a rate of falls and major fractures, including hip fractures, similar to that of the group receiving atypical antipsychotics. But, trazadone was associated with a lower risk of death in these patients.

"As clinicians move to decrease antipsychotic use, we should not consider trazadone as a uniformly safer alternative to atypical antipsychotics, because trazadone 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.

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 may exhibit aggressive behaviour. Although evidence is limited on efficacy, antipsychotics and trazadone, 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 trazadone and 2875 newly dispensed an atypical antipsychotic. They found that patients dispensed trazadone had a rate of falls and major fractures, including hip fractures, similar to that of the group receiving atypical antipsychotics. However, trazadone 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.

The researchers also emphasize the need for prioritizing nonpharmacological approaches comprising of a variety of behavioural, environmental and caregiver-supportive interventions for the management of behavioural and psychological symptoms of dementia.

For more details click on the link: DOI: https://doi.org/10.1503/cmaj.180551