Cyclic antidepressants and the risk of hip fracture

Article Abstract:

The class of drugs known as cyclic antidepressants produces a number of serious side effects, such as sedation and blood pressure drops upon standing that lead to lightheadedness. These side effects are thought to increase the risk of falls and injuries, particularly in the elderly. A study was done comparing over 4,500 patients with hip fractures with over 24,000 patients without hip fractures, to determine the rate of cyclic antidepressant use. Typically, those with hip fractures were women (73 percent), and were over the age of 75 (79 percent). Cyclic antidepressants were being used by 3.2 percent of the hip fracture patients and 1.8 percent of the control sample, giving a 1.6 times (or 60 percent) greater risk for hip fracture among users of cyclic antidepressants. The two groups did not differ significantly in terms of age, sex, likelihood of residing in a nursing home, or existing medical problems, making the use of cyclic antidepressants the likely reason for the increased risk of falls and fractures. Of some concern is the fact that a significant proportion of patients prescribed cyclic antidepressants were given them as sleeping aids, rather than as treatment for depression. Since these drugs persist in the bloodstream for extended periods of time, they are likely to be present in sufficient quantity upon awakening to continue having sedative effects. Because of the increased risk of falls and hip fractures in the elderly who are taking cyclic antidepressants, great caution should be employed in prescribing these drugs to older patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Dosage and administration, Drug use, Hip joint, Hip fractures, Frail elderly, Antidepressants, Tricyclic, Tricyclic antidepressants

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Effect of a prior-authorization requirement on the use of nonsteroidal antiinflammatory drugs by Medicaid patients

Article Abstract:

A prior-authorization policy appears to be extremely effective in controlling the use of nongeneric nonsteroidal antiinflammatory drugs (NSAIDs) by Medicaid patients. Prior authorization means that a doctor can not prescribe a drug for a Medicaid patients without state approval. Following the initiation of the policy in the Tennessee Medicaid program in 1989, prescription costs for NSAIDs promptly dropped 65%. Two years later, expenditures for NSAIDs dropped 53%, savings the state about $12.8 million. Enrollment in the Medicaid program totaled 547,403 people. Cheaper generic NSAIDS were used more frequently and general NSAID use declined. NSAIDs are used most often to treat symptoms of musculoskeletal disorders.

Finance, Nonsteroidal anti-inflammatory drugs, Nonsteroidal anti-inflammatory agents, Medicaid

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Antidepressants and the risk of falls among nursing home residents

Article Abstract:

Nursing home patients who take selective serotonin reuptake inhibitors may be just as likely to fall as patients who take other antidepressants. Selective serotonin reuptake inhibitors include drugs such as Prozac, and are believed to have fewer side effects. But in a study of 2,428 nursing home patients on various antidepressants, those taking selective serotonin reuptake inhibitors were just as likely to fall as those taking tricyclics or trazodone. All patients on antidepressants were more likely to fall than patients not taking antidepressants.

Risk factors, Falls (Accidents), Accidental falls, Antidepressants, Serotonin uptake inhibitors, Selective serotonin reuptake inhibitors

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