| Abstract | Cilj je ovog istraživanja bio odrediti udio starijih osoba u primarnoj zdravstvenoj zaštiti koje koriste
benzodiazepine (BZD), analizirati vrstu, dozu, trajanje terapije i način primjene BZD-a te ustanoviti
postoji li potencijal za depreskripciju BDZ-a. Također su analizirane klinički značajne interakcije između
BZD-a i ostalih lijekova te dodataka prehrani.
Istraživanje je provedeno na uzorku od 264 pacijenata starije životne dobi (>65 godina), u javnim
ljekarnama na području Zagreba, Istre i Kvarnera, u periodu od ožujka 2019. do ožujka 2020. godine.
Dio je većeg istraživanja koje se provodi u više europskih zemlja u sklopu projekta EuroAgeism Horizon
2020. Za potrebe istraživanja definirano je četiri kriterija za depreskripciju, koristeći kanadske,
australske i tasmanijske smjernice za depreskripciju BZD-a te podatke navedene u Sažetku opisa
svojstava lijekova, na temelju kojih se odlučivalo o tome koji ispitanici bi mogli imati koristi od
depreskripcije ovih lijekova.
U ispitivanju je sudjelovalo 264 pacijenata, od kojih je 35,2 % muškaraca i 64,8 % žena prosječne dobi
74,49 (SD=6,81) godina. Ispitanici su koristili prosječno 5,97 ± 3,17 lijekova, BZD je koristilo 90 ispitanika
(34,2 %), najčešće diazepam (n=41, 45,6 %) i alprazolam (n=25, 27,8 %). Najčešće indikacije za
korištenje BZD-a bili su problemisa spavanjem (n=36, 40,0 %), anksioznost (n=26, 28,9 %) i kombinacija
anksioznosti i nesanice (n=9, 10,0 %). Najviše ispitanika, njih 70 % (63 ispitanika), zadovoljilo je kriterij
C za depreskripciju BZD-a koji se odnosio na trajanje terapije (duže od 12 tjedana). 30 % ispitanika
imalo je prekoračenu preporučenu maksimalnu dnevnu dozu za starije osobe. Dobiveni rezultati
pokazali su da bi 75 pacijenata (83,3 %) moglo imati koristi od depreskripcije. Osim toga, pokazalo se
da bi se svim ispitanicima koji koriste BZD trebalo pristupiti s ciljem revizije terapije.
Iz dobivenih rezultata dalo bi se zaključiti o potrebi za racionalnijim korištenjem BDZ-a u starijih osoba
na razini primarne zdravstvene zaštite. Potrebno je podići svijest o problemu prekomjernog
propisivanja BZD-a starijima kao rizičnoj skupini te educirati liječnike i ljekarnike o alternativnim
terapijskim mogućnostima. Također valja obratiti pažnju na interakcije između BZD-a i drugih lijekova,
osobito onih koji djeluju na SŽS, iz razloga što mogu povećati rizik nuspojava, padova i lomova.
Smjernice i kriteriji za depreskripciju mogle bi biti koristan alat za racionalniju primjenu BZD-a. |
| Abstract (english) | The goals of this study were to determine the percentage of older people in Croatian primary health
care who use benzodiazepines (BZD) and to characterize those drugs by type of drug, dose, and duration
of treatment. The study also aimed to estimate the need for deprescribing BZD and analyse clinically
significant interactions between BZD and other medications, including over-the-counter drugs.
A total of 264 older patients (>65 years) from two regions (Zagreb and Istra and Kvarner) were included
in this study. Data were collected from patients in community pharmacies using a standardized
questionnaire between March 2019 and May 2020. This study is part of a larger study conducted in
several European countries as part of the EuroAgeism Horizon 2020 project. To determine which
patients could benefit from deprescribing BZD, four criteria for deprescribing were defined using
Canadian, Australian, and Tasmanian guidelines, as well as the Summary of Product Characteristics of
the drugs analysed.
Of the 264 patients included in the study, 35.2% were male and 64.8% were female, with a mean age
of 74.49 (SD=6.81) years. On average, patients used 5.97 ± 3.17 drugs, with 90 patients (34.2%) using
BZD. Diazepam was the most commonly used BZD (n=41, 45.6%), followed by alprazolam (n=25,
27.8%). The most common indications for BZD use were insomnia (n=36, 40.0%), anxiety (n=26, 28.9%),
and a combination of both (n=9, 10.0%). The majority of patients (n=63, 70%) used BZD for more than
12 weeks, which met the criteria for deprescribing. 30% of the patients exceeded the recommended
maximum daily dosage for older adults. The results indicated that at least 75 patients (83.3%) could
benefit from deprescribing BZD. Furthermore, all patients who participated in this study and used BZD
should have their therapy reviewed and optimized.
The results of this study highlight the need for the rationalization of BZD use in older adults in primary
care settings. There is a necessity to raise awareness about prescribing BZD drugs to older adults and
educate doctors and pharmacists about alternative therapeutic options. Additionally, attention should
be given to interactions between BZD drugs and other medications, especially those with an impact on
the central nervous system, as their combined use can increase the risk of side effects, falls, and
fractures. Guidelines and criteria for deprescribing can serve as useful tools in rationalizing the usage
of BZD drugs among older adults. |
