Non-GABA sleep medications, suvorexant as risk factors for falls: Case-control and case-crossover study

Abstract

The aim of this study was to examine the risk of falls associated with the use of non-gamma amino butyric acid (GABA) sleep medications, suvorexant and ramelteon. This case-control and case-crossover study was performed at the Kudanzaka Hospital, Chiyoda Ward, Tokyo. A total of 325 patients who had falls and 1295 controls matched by sex and age were included. The inclusion criteria for the case group were hospitalized patients who had their first fall and that for the control were patients who were hospitalized and did not have a fall, between January 2016 and November 2018. The internal sleep medications administered were classified as suvorexant, ramelteon, non-benzodiazepines, benzodiazepines, or kampo. In the case-control study, age, sex, clinical department, the fall down risk score, and hospitalized duration were adjusted in the logistic regression model. In the case-control study, multivariable logistic regression showed that the use of suvorexant (odds ratio [OR]:

Association of drugs with special caution in the guidelines with falls: A case–control and case–crossover study in Japan

“…Retrospective case–control and case–crossover studies were carried out at Kudanzaka Hospital (231 beds) in Chiyoda‐ward, Tokyo, Japan. We collected data of hospitalized patients (case group) who experienced their first falls when hospitalized between January 2016 and November 2018 18 . No exclusion criteria, such as age, departments and falls before hospitalization, were applied to the case group.…”

“…The sample size was determined based on the number of falls collected during the recruitment period. In determining the sample size to be used in this study, we used the size of the fall group determined by a previous study that examined the risk of falls due to sleep medications 18 . The association between medications use and falls was assessed by conditional logistic regression analysis using odds ratio (OR) and a 95% confidence interval (CI).…”

Association of orexin receptor antagonists with falls during hospitalization

“…Regarding suvorexant, Torii et al reported that suvorexant was not significantly associated with falls (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.06–1.06) 10 . However, Ishibashi et al found that the drug significantly increased the fall risk (OR = 2.61, 95% CI = 1.29–5.28) 11 . Similarly, the effects of suvorexant on fall risk have also been inconsistent in prior research.…”

Ramelteon protects against human pulmonary microvascular endothelial cell injury induced by lipopolysaccharide (LPS) via activating nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway

“…For this reason, ramelteon is mostly used clinically in the treatment of chronic insomnia [ 10 ]. In addition, as ramelteon does not bind to neurotransmitter receptors, it has been revealed to avoid the distraction associated with neurotransmitter receptor drugs and thus has no potential for drug addiction or dependence [ 11 ]. However, ramelteon has anti-inflammatory and antioxidant properties, and ameliorates cellular damage [ 12 ].…”