| Abstract | Cilj istraživanja: benzodiazepini se ubrajaju među lijekove s najširim indikacijskim
područjem i najvećom potrošnjom. Sklonost razvoju ovisnosti udružena s rizikom od pada i
kognitivnih poremećaja čini osobe starije životne dobi podložnima nepovoljnim ishodima uz
njihovu primjenu. Cilj istraživanja je utvrditi učestalost i karakteristike primjene
benzodiazepina i učestalost padova kod osoba starije životne dobi smještenih u domu te
istražiti koliko su te pojave povezane. Istražit će se i pojavnost potencijalnih klinički
značajnih interakcija benzodiazepina s drugim lijekovima, biljnim preparatima i alkoholom
koje mogu rezultirati depresijom središnjeg živčanog sustava.
Ispitanici i metode: opservacijsko istraživanje provedeno je u razdoblju od 15. do 20.
ožujka 2019. godine u Domu za starije osobe Bjelovar. U razgovoru s ispitanicima izrađen je
popis korištenih lijekova te su od osoba koje koriste benzodiazepine prikupljeni podaci o dozi,
indikaciji, duljini primjene i propisivaču lijeka. Sve osobe upitane su o prisutnosti padova u
posljednjih godinu dana. Za utvrđivanje potencijalnih klinički značajnih interakcija
benzodiazepina s drugim lijekovima korišten je program Lexi-Comp® Drug Interactions.
Statistička obrada podataka provedena je u programu Statistica.
Rezultati: u istraživanju je sudjelovalo 105 osoba prosječne dobi 80,3 (± 6,5) godine, od
kojih je 70 (66,7 %) bilo ženskog spola. Prosječan broj korištenih lijekova po ispitaniku
iznosio je 7,1 (± 3,8). Primjena benzodiazepina zabilježena je kod 56 (53,3 %) ispitanika,
češće kod žena. Najzastupljeniji benzodiazepini su alprazolam, diazepam i lorazepam, a
najčešće indikacije za primjenu su smirenje i opuštanje te problemi sa spavanjem. Najviše
benzodiazepina propisuju liječnici obiteljske medicine. U 86,7 % slučajeva radi se o primjeni
duljoj od godine dana, od čega je u 36,7 % slučajeva primjena dulja od pet godina. Kod 37
(66,1 %) korisnika benzodiazepina zabilježeno je ukupno 68 potencijalnih klinički značajnih
interakcija (stupnja značajnosti D i C) koje kao posljedicu mogu imati depresiju središnjeg
živčanog sustava, najviše s tramadolom, zolpidemom i moksonidinom. Kod 40 (38,1 %)
ispitanika zabilježeni su padovi u posljednjih godinu dana, češće kod žena, osoba koje koriste
veći broj lijekova i koje koriste depresore središnjeg živčanog sustava.
Zaključak: benzodiazepini su vrlo učinkoviti i korisni lijekovi, no njihovom
neracionalnom i nekontroliranom primjenom moguće je izazvati teške posljedice za
bolesnika. Potrebno je redovito procjenjivati učinkovitost i reevaluirati dozu i trajanje terapije
kako bi se spriječio razvoj tolerancije i ovisnosti. Rezultati istraživanja u domu za starije
osobe pokazuju veliku potrošnju benzodiazepina i primjenu koja nije u skladu s
farmakoterapijskim smjernicama za starije osobe. Neprikladna primjena depresora središnjeg
živčanog sustava jedan je od čimbenika koji utječu na učestalost padova kod ispitanika. |
| Abstract (english) | Objectives: benzodiazepines are among the medicines with the widest range of
indications and the highest consumption. The tendency to develop addiction combined with
the risk of falling and cognitive impairment makes elderly persons susceptible to unfavorable
outcomes of their application. The aim of the research is to determine the frequency and the
characteristics of the use of benzodiazepines and the incidence of falls in elderly persons in a
nursing home, as well as to examine how these phenomena are related. The occurrence of
potential clinically significant interactions of benzodiazepines with other drugs, herbal
preparations and alcohol, which may result in central nervous system depression will also be
examined.
Patients and methods: the observational study was conducted in the period March 15 to
March 20 2019 in Bjelovar Nursing Home (Dom za starije osobe Bjelovar). In conversations
with the respondents a list of medications used was created, and the data on the dosage,
indications, duration of use and the prescribers of the drugs were collected from the persons
who were using benzodiazepines. All respondents were questioned about occurrence of falls
in the past year. The Lexi-Comp® Drug Interactions software was used to determine the
potential clinically significant interactions of benzodiazepines with other drugs. Statistical
data analysis was carried out using the Statistica software package.
Results: the study involved 105 persons of average age at 80,3 (±6,5) years, 70 (66,7 %)
of whom were female. The average number of drugs used per respondent was 7,1 (±3,8). The
use of benzodiazepines was observed in 56 (53,3 %) respondents, more often in women. The
most commonly used benzodiazepines were alprazolam, diazepam and lorazepam, and the
most common indications for use were restlessness and relaxation, and sleep disorders. Most
benzodiazepines were prescribed by family physicians. In 86,7 % of the cases
benzodiazepines had been used for more than one year, 36,7 % of which were cases where
they had been used for more than five years. In 37 (66,1 %) of the benzodiazepine users, there
were a total of 68 potential clinically significant interactions of benzodiazepines (clinical
significance degree D and C) that might lead to central nervous system depression, mostly
with tramadol, zolpidem and moxonidine. In 40 (38,1 %) of the respondents falling had been
recorded in the past year, more often in the following groups: women, persons who used a
larger number of drugs, and persons who used central nervous system depressants.
Conclusion: benzodiazepines are highly effective and useful drugs but their unreasonable
and uncontrolled use can cause severe consequences for patients. It is necessary to evaluate
efficacy and re-evaluate the dosage and duration of therapy regularly in order to prevent the
development of drug tolerance and addiction. The results of the research conducted at the
nursing home show a high consumption of benzodiazepines and a use that does not comply
with pharmacotherapy guidelines for older adults. Improper use of central nervous system
depressants is one of the factors that affect the frequency of falls in the respondents. |
