Trazodone utilization among the elderly in Spain. A population based study

Saint-Gerons, Diego Macías; Huerta, Consuelo; Poza, Patricia García; Corominas, Dolores Montero; Honrubia, César de la Fuente

doi:10.1016/j.rpsm.2016.11.003

Cited by 15 publications

(6 citation statements)

References 17 publications

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“…In our previous study on AMI, 10 we observed a remarkable reduced risk associated with the use of SARIs, similar to the one found with SSRIs. In the present study, results did not reach statistical significance and, then, we cannot conclude that the use of SARIs is associated with a reduced risk, but at least an increased risk can be ruled out, which is reassuring taking into account that trazodone is widely used in the elderly at low doses (100 mg or lower) for its hypnotic properties, 35 mainly because of the antagonism on H 1 receptors. 36 The increased risk associated with TCA-serotonin and SNRI during the first year of treatment should be further studied, as we cannot rule out the possibility of a residual confounding by indication (in case these drugs were more prescribed for severe cases).…”

Section: Discussioncontrasting

confidence: 74%

Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study

Alqdwah-Fattouh

Rodríguez‐Martín

Barreira-Hernández

et al. 2022

Stroke

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Background: Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. Methods: A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. Results: A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97–1.34) as compared with nonusers, 0.94 (95% CI, 0.77–1.13) as compared with past-users and 0.74 (95% CI, 0.58–0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (≤1, >1 year), sex, age (<70, ≥70 years old) and background vascular risk. Conclusions: The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.

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Section: Discussioncontrasting

confidence: 74%

Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study

Alqdwah-Fattouh

Rodríguez‐Martín

Barreira-Hernández

et al. 2022

Stroke

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“…After World War II, these drugs were repurposed as antirheumatic drugs [42]. Drug repositioning (also known as drug repurposing or drug reprofiling) is a process of developing new indications for existing drugs [43]. Despite CQ being the most widely used antimalarial drug in history [9], in our study, reports of TdP and HCQ or CQ mostly originated in Europe and North America for the treatment of autoimmune diseases and for the treatment of COVID-19 from 2020 onwards.…”

Section: Discussionmentioning

confidence: 78%

Torsade de pointes associated with chloroquine, hydroxychloroquine, and azithromycin: a retrospective analysis of individual case safety reports from VigiBase

Saint-Gerons

Tabarés‐Seisdedos

2021

Eur J Clin Pharmacol

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Purpose To analyze the cases of torsade de pointes (TdP) and related symptoms reported in association with chloroquine (CQ), hydroxychloroquine (HCQ), and azithromycin (AZT) to the World Health Organization (WHO) global database of individual case safety reports (ICSRs) for drug monitoring (VigiBase) using qualitative and quantitative pharmacovigilance approaches. Methods The main characteristics of the ICSRs reporting TdP with CQ, HCQ, and AZT have been summarized. Co-reported drugs with risk to cause QT prolongation have been described. Reporting odds ratios (RORs) as a measure of disproportionality for reported TdP and individual drugs have been calculated. Results One hundred seventy ICSRs reporting TdP in association with the drugs of interest were identified (CQ: 11, HCQ: 31, CQ + HCQ: 1, HCQ + AZT: 27, AZT: 100). From these, 41 (24.3%) were received during the pandemic period (December 2019 to February 2021). The median age of the patients was 63, 53, and 63 years old for CQ, HCQ, and AZT, respectively. Reports included concomitant use of other QT-prolonging drugs (CQ 25.0%, HCQ 71.2%, AZT 64.6%). A proportion of the cases were fatal (CQ 25.0%, HCQ 8.6%, AZT 16.1%). Increased disproportionality has been found for the individual drugs and TdP: CQ (ROR: 7.41, 95% confidence interval (CI): 3.82, 12.96), HCQ (ROR: 8.49, 95% CI: 6.57, 10.98), azithromycin (ROR: 8.06, 95% CI: 6.76, 9.61). Disproportionality was also found for other related symptoms, Standardized MedDRA Query for torsade de pointes/QT prolongation (narrow): CQ (ROR: 11.95, 95% CI: 10.04–14.22); HCQ (ROR: 20.43, 95% CI: 19.13, 21.83), AZT (ROR: 7.78, 95% CI: 7.26, 8.34). Conclusions The prescription of CQ, HCQ, and AZT should be restricted to therapeutic indications with established positive benefit/risk profile. Doctors and patients should be aware of this potential adverse reaction especially when several risk factors are present. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03133-w.

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“…The use of trazodone concomitantly with potentially interacting medicines was frequent: anti-hypertensives (53.60%), and CNS depressors (59.32%). 33 …”

Section: Resultsmentioning

confidence: 99%

Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights

Fagiolini,

González Pinto,

Miskowiak

et al. 2023

NDT

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Objective Major depressive disorder (MDD) often co-occurs with dementia and other neurological disorders, and treatment with antidepressants can improve symptoms, quality of life, and survival in these patients. This narrative review provides an expert opinion about the role and effectiveness of trazodone in the treatment of older adults with MDD and cognitive impairment due to physical illnesses, such as dementia. Results Because of its mechanism of action, trazodone can treat several depression symptoms often seen in people with dementia, including insomnia, agitation, anxiety, cognitive impairment, and irritability. Conclusion Trazodone may be beneficial for patients with dementia or other neurological disorders comorbid with MDD, especially when the clinical picture of depression includes or is comorbid to symptoms of insomnia, irritability, inner tension, anxiety, or psychomotor agitation.

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Trazodone utilization among the elderly in Spain. A population based study

Cited by 15 publications

References 17 publications

Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study

Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study

Torsade de pointes associated with chloroquine, hydroxychloroquine, and azithromycin: a retrospective analysis of individual case safety reports from VigiBase

Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights

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