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Combinations increase risk of falls, respiratory suppression, cognitive impairment.
Of nearly 1.2 million Medicare beneficiaries with dementia, 13.9% were prescribed CNS-active polypharmacy, defined as more than 30 days of overlap for at least three drugs that were antidepressants, antipsychotics, anti-epileptics, benzodiazepines, non-benzodiazepine receptor agonist hypnotics, or opioids, reported Donovan Maust, MD, MS, of University of Michigan in Ann Arbor, and co-authors in JAMA.
Gabapentin (Neurontin) — a drug approved for seizures, nerve pain, and restless legs syndrome that’s frequently used for off-label indications — was the most common medication and was associated with 33% of polypharmacy-days.
After gabapentin, the next most-prescribed medications that contributed to polypharmacy were trazodone at 26.0% and quetiapine (Seroquel) at 24.4%. “I suspect quetiapine, while considered an antipsychotic, is being used frequently for sleep or for anxiety,” Maust noted.
The remaining medications in the top 10 spots were the antidepressant drugs mirtazapine (Remeron) at 19.9%, sertraline (Zoloft) at 18.7%, escitalopram (Lexapro) at 14.7%, and duloxetine (Cymbalta) at 14.5%, followed by three benzodiazepines: lorazepam (Ativan) at 12.9%, clonazepam (Klonopin) at 12.0%, and alprazolam (Xanax) at 12.0%. The most common opioids were hydrocodone (11.5%) and tramadol (9.2%).