Dementia: trazodone no safer than atypical antipsychotics for falls, fractures

  • Watt JA & al.
  • CMAJ
  • 26 Nov 2018

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Older adults with dementia prescribed trazodone (Desyrel, others) had similar risks for falls and fractures as counterparts prescribed atypical antipsychotics.

Why this matters

Key results

  • Most patients dispensed atypical antipsychotics (95.2%) received a low dose.
  • Relative to atypical antipsychotics, trazodone was statistically indistinguishable on 90-day:
    • composite of falls, major osteoporotic fractures (weighted HR, 0.89; 95% CI, 0.73-1.07);
    • falls (0.91; 0.75-1.11);
    • major osteoporotic fractures (1.03; 0.73-1.47); and
    • hip fractures (0.92; 0.59-1.43).
  • Trazodone group was less likely to die (weighted HR, 0.75; 95% CI, 0.66-0.85).
  • No significant difference on cataract surgery (weighted HR, 0.67; 95% CI, 0.33-1.34).

Study design

  • Canadian retrospective cohort study of adults aged ≥66 years with dementia (excluding those with chronic psychotic illnesses) living in long-term care.
  • Main outcome: composite of falls and major osteoporotic fractures within 90 days of first prescription.
  • Analyses compared:
    • 6588 new users of trazodone.
    • 2875 new users of atypical antipsychotics: quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal).
  • Funding: breaKThrough (knowledge translation) Program of St. Michael’s Hospital.

Limitations

  • Potential unmeasured confounding.
  • Only falls leading to hospital contact captured.
  • Uncertain generalizability.

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