Elderly people take several different drugs at the same time, common is use of analgesics and drugs for treatment of insomnia. Due to concomitant diseases and polypharmacotherapy treatment of pain and insomnia represents a great challenge in elderly.
The study evaluated the adequacy of pharmacotherapy for insomnia and pain among elderly in the retirement home in Metlika. Among these drugs we checked whether they were potentially inappropriate for the elderly and if there was a risk for potential drug-drug interactions with other concomitant drugs.
In the study we included residents of the retirement home Metlika, who were at least 65 years old and received prescription drugs for systemic treatment of insomnia and/or pain, either for regular use or when needed. All the necessary data was obtained in the retirement home from a doctor’s medical documentation on the selected day in the year 2018. Adequacy of individual drugs was evaluated using guidelines for pharmacotherapy of insomnia or pain and PRISCUS list, dose adequacy was checked using the Summary of Product Characteristics and potential drug-drug interactions were identified by Lexicomp datebase.
Among all the residents of the retirement home, 98 of them received drugs for the treatment of insomnia and/or pain. 62 (63.3%) of them were women, with an average age of 84,9 years, and 36 (36.7%) were men, with an average age of 77.9 years. Drugs for insomnia were prescribed to 77 (78.6%) residents. Altogether they received 8 different drugs, the most commonly zolpidem (47 prescriptions), followed by benzodiazepines (alprazolam, bromazepam, diazepam and lorazepam) and quetiapine. According to the European guidelines these drugs are not recommended for long-term use. Among all prescribed drugs for insomnia, only quetiapine, trazodone and clomethiazole are not potentially inappropriate drugs for elderly.
Drugs for treatment of pain were prescribed to 87 (88.8%) residents and altogether they received 12 different drugs. Most of the residents (66.7%) were taking a combination of tramadol and paracetamol, followed by paracetamol and metamizole. According to the guidelines the use of long-acting non-steroidal anti-inflammatory drugs (in our case indomethacin and etoricoxib) are not recommended for the treatment of pain in elderly. Among the prescribed drugs for treatment of pain only indomethacin and etorocoxib belong to potentially inappropriate drugs for elderly. Maximum daily doses of drugs for treatment of insomnia or pain were exceeded in 5 residents. We identified potential drug interactions in 77 (78.5%) residents. All together we identified 212 interactions of type D and 9 interactions of type X. Most interactions of type D were caused by tramadol, zolpidem and quetiapine and most interactions of type X were caused by quetiapine.