Pharmaceutical Society of Australia
The Pharmaceutical Society of Australia (PSA) is the peak national professional pharmacy organisation and represents Australia’s 30,000 pharmacists working in all sectors and locations. PSA’s core functions include: providing continuing professional development, education and practice support; developing and advocating standards and guidelines; and representing pharmacists’ role as frontline health professionals.
5.
Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
The use of benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium is associated with a range of adverse effects including falls and impaired cognition. Non-pharmacological interventions can be an effective substitute and use of these medicines should be for the shortest duration possible. Reductions in the use of these medicines can be achieved following pharmacist review, interdisciplinary input, staff education and feedback from audits.
Supporting evidence
- Díaz-Gutiérrez MJ, Martínez-Cengotitabengoa M, Sáez de Adana E, et al. Relationship between the use of benzodiazepines and falls in older adults: A systematic review. Maturitas. 2017;101:17-22.
- Yu NW, Chen PJ, Tsai HJ, et al. Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan. BMC Geriatr. 2017;17:140.
- Declercq T, Petrovic M, Azermai M, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev 2013;(3):CD007726.
- Ma H, Huang Y, Cong Z, et al. The efficacy and safety of atypical antipsychotics for the treatment of dementia: a meta-analysis of randomized placebo-controlled trials. J Alzheimers Dis 2014;42(3):915-37.
- Richter T, Meyer G, Mohler R, et al. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2012;(12):CD008634.
- Westbury JL, Gee P, Ling T, et al. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. Med J Aust 2018; 208(9):398-403. doi: 10.5694/mja17.00857
- Alessi C, Vitello M. Insomnia (primary) in older people: non-drug treatments. BMJ Clin Evid. 2015;2302
- Sawan M, Jeon Y, Chen T. Psychotropic medicines use in residents and culture: influencing clinical excellence (PRACTICE) tool. A development and content validation study. Research in Social and Administrative Pharmacy. 2018 https://doi.org/10.1016/j.sapharm.2018.08.015
How this list was made
A working party of members of the Pharmaceutical Society of Australia (PSA) was established. Members of the State and Territory Branch Committees were invited to contribute suggested recommendations. Over 40 recommendations were submitted. The working party grouped the recommendations into themes, eliminated ones that were out of scope, reduced the list to twelve and refined the wording. All PSA members were sent an online survey to rank the proposed recommendations, indicate how likely they would be to implement the recommendations in practice, and suggest additional items for consideration.
Based on the survey responses, six recommendations were shortlisted and supporting evidence gathered. The final list was signed off by the PSA Board in November 2018.
Note: PSA uses Vancouver reference style. Where there are more than three authors, only the first three are listed followed by et al.
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1
Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
- 2 Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
- 3 Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
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4
Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
- 5 Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
- 6 Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.