Benzodiazepines are widely prescribed in older patients. Studies have shown that these medication... more Benzodiazepines are widely prescribed in older patients. Studies have shown that these medications can increase the risk of falls, hip fractures, cognitive impairment, delirium, dementia, traffic accidents, drug dependence and mortality. Guidelines and expert consensus statements addressing the adverse effects of chronic benzodiazepine use have not been effective in changing prescribing practices. Different interventions have been published to decrease or stop benzodiazepines. In the elderly, benzodiazepine withdrawal under medical supervision coupled with psychotherapy has been shown to work. For pragmatic reasons (access to psychotherapy not always available), medication review coupled with patient education should be tried. There is no evidence to support a substitution of a short/intermediate half-life benzodiazepine for a long half-life benzodiazepine. Tapering a benzodiazepine should be initiated with the benzodiazepine the patient is currently taking. Using different formulations of a particular drug should also be considered to facilitate reductions in dosage. The optimal duration of withdrawal varies with each patient, and a flexible tapering schedule is suggested at a reduction rate that is acceptable for that individual. An illustration of a sample schedule to discontinue for oxazepam is presented.
Formulaire pour la divulgation de conflits d’interets potentiels. Il est disponible sur le site W... more Formulaire pour la divulgation de conflits d’interets potentiels. Il est disponible sur le site Web du Pharmactuel www.pharmactuel.com sous la rubrique recommandations aux auteurs. Au moment de la soumission d’un article, chaque auteur doit remplir et soumettre ce formulaire, le but de cette demarche etant de fournir aux lecteurs du Pharmactuel des renseignements au sujet des interets de l’auteur susceptibles d’influencer la perception et l’interpretation de son travail d’ecriture.
Background our aim was to assess the effectiveness of medication review and deprescribing interve... more Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records title/abstract and full-text screening by two reviewers. Risk of bias Cochrane Collaboration revised tool. Data synthesis results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fa...
Objective: To describe a case of standard treatment–refractory hyperemesis gravidarum in which th... more Objective: To describe a case of standard treatment–refractory hyperemesis gravidarum in which the patient’s condition improved following the administration of oral clonidine. Case summary: A pregnant 32-year-old woman was admitted to hospital at 14 weeks’ gestation. She was vomiting, with hypersalivation, epigastralgia, weight loss, ketonuria and hypokalemia, leading to a diagnosis of hyperemesis gravidarum. Several treatments were used to relieve the symptoms: hydration, pyridoxine, diphenhydramine, metoclopramide, ranitidine, pantoprazole, and ondansetron. Finally, oral clonidine was prescribed, resulting in the patient’s significant and lasting symptomatic relief from hyperemesis gravidarum. Discussion: Hyperemesis gravidarum is a complication of pregnancy in up to 2% of cases. A number of drugs can be used for this condition, but some patients do not respond to the usual treatment. Clonidine is a central alphaadrenergic agonist used mainly as an antihypertensive. Limited data e...
Patients : Les patients admis dans cette etude etaient des hommes et des femmes âges de 40 a 80 a... more Patients : Les patients admis dans cette etude etaient des hommes et des femmes âges de 40 a 80 ans, avec une concentration serique de cholesterol total nona-jeun d’au moins 3,5 mmol/L et presentant un risque eleve de mortalite cardio-vasculaire dans les 5 ans puisqu’ils avaient les antecedents medicaux suivants : soit (1) une maladie coronarienne (infarctus du myocarde, angine stable ou instable, angioplastie ou pontage coronarien); ou (2) une autre pathologie arterielle occlusive d’origine non coronarienne (accident vasculaire cerebral [AVC] non hemorragique non debilitant, ischemie cerebrale transitoire, claudication intermittente, endarterectomie des carotides, autre chirurgie arterielle ou angioplastie arterielle); ou (3) un diabete de type I ou II; ou (4) une hypertension traitee chez des hommes de plus de 65 ans.
Benzodiazepines are widely prescribed in older patients. Studies have shown that these medication... more Benzodiazepines are widely prescribed in older patients. Studies have shown that these medications can increase the risk of falls, hip fractures, cognitive impairment, delirium, dementia, traffic accidents, drug dependence and mortality. Guidelines and expert consensus statements addressing the adverse effects of chronic benzodiazepine use have not been effective in changing prescribing practices. Different interventions have been published to decrease or stop benzodiazepines. In the elderly, benzodiazepine withdrawal under medical supervision coupled with psychotherapy has been shown to work. For pragmatic reasons (access to psychotherapy not always available), medication review coupled with patient education should be tried. There is no evidence to support a substitution of a short/intermediate half-life benzodiazepine for a long half-life benzodiazepine. Tapering a benzodiazepine should be initiated with the benzodiazepine the patient is currently taking. Using different formulations of a particular drug should also be considered to facilitate reductions in dosage. The optimal duration of withdrawal varies with each patient, and a flexible tapering schedule is suggested at a reduction rate that is acceptable for that individual. An illustration of a sample schedule to discontinue for oxazepam is presented.
Formulaire pour la divulgation de conflits d’interets potentiels. Il est disponible sur le site W... more Formulaire pour la divulgation de conflits d’interets potentiels. Il est disponible sur le site Web du Pharmactuel www.pharmactuel.com sous la rubrique recommandations aux auteurs. Au moment de la soumission d’un article, chaque auteur doit remplir et soumettre ce formulaire, le but de cette demarche etant de fournir aux lecteurs du Pharmactuel des renseignements au sujet des interets de l’auteur susceptibles d’influencer la perception et l’interpretation de son travail d’ecriture.
Background our aim was to assess the effectiveness of medication review and deprescribing interve... more Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records title/abstract and full-text screening by two reviewers. Risk of bias Cochrane Collaboration revised tool. Data synthesis results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fa...
Objective: To describe a case of standard treatment–refractory hyperemesis gravidarum in which th... more Objective: To describe a case of standard treatment–refractory hyperemesis gravidarum in which the patient’s condition improved following the administration of oral clonidine. Case summary: A pregnant 32-year-old woman was admitted to hospital at 14 weeks’ gestation. She was vomiting, with hypersalivation, epigastralgia, weight loss, ketonuria and hypokalemia, leading to a diagnosis of hyperemesis gravidarum. Several treatments were used to relieve the symptoms: hydration, pyridoxine, diphenhydramine, metoclopramide, ranitidine, pantoprazole, and ondansetron. Finally, oral clonidine was prescribed, resulting in the patient’s significant and lasting symptomatic relief from hyperemesis gravidarum. Discussion: Hyperemesis gravidarum is a complication of pregnancy in up to 2% of cases. A number of drugs can be used for this condition, but some patients do not respond to the usual treatment. Clonidine is a central alphaadrenergic agonist used mainly as an antihypertensive. Limited data e...
Patients : Les patients admis dans cette etude etaient des hommes et des femmes âges de 40 a 80 a... more Patients : Les patients admis dans cette etude etaient des hommes et des femmes âges de 40 a 80 ans, avec une concentration serique de cholesterol total nona-jeun d’au moins 3,5 mmol/L et presentant un risque eleve de mortalite cardio-vasculaire dans les 5 ans puisqu’ils avaient les antecedents medicaux suivants : soit (1) une maladie coronarienne (infarctus du myocarde, angine stable ou instable, angioplastie ou pontage coronarien); ou (2) une autre pathologie arterielle occlusive d’origine non coronarienne (accident vasculaire cerebral [AVC] non hemorragique non debilitant, ischemie cerebrale transitoire, claudication intermittente, endarterectomie des carotides, autre chirurgie arterielle ou angioplastie arterielle); ou (3) un diabete de type I ou II; ou (4) une hypertension traitee chez des hommes de plus de 65 ans.
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