- Older adults with dementia prescribed trazodone (Desyrel, others) had similar risks for falls and fractures as counterparts prescribed atypical antipsychotics.
Why this matters
- 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).
- 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.
- Potential unmeasured confounding.
- Only falls leading to hospital contact captured.
- Uncertain generalizability.