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Helen-maria Vasiliadis - One of the best experts on this subject based on the ideXlab platform.
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Sedative-Hypnotic Medicines and Falls in Community-Dwelling Older Adults: A Cost-Effectiveness (Decision-Tree) Analysis from a US Medicare Perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Dharmender Singh, Sylvie Perreault, Helen-maria VasiliadisAbstract:BackgroundBoth the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative Hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.ObjectiveThe aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-Hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences.MethodsA model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis.ResultsOn an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative Hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative Hypnotics (−US$4,851) and no treatment (−US$7,993). CBT had a 95 % chance of being the dominant strategy, with results most sensitive to an older adult’s baseline risk of falling.ConclusionFailure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-Hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-Hypnotic drugs as first-line treatment for insomnia in older adults.
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sedative Hypnotic medicines and falls in community dwelling older adults a cost effectiveness decision tree analysis from a us medicare perspective
Drugs & Aging, 2015Co-Authors: Cara Tannenbaum, Vakaramoko Diaby, Mireille Luc, Helen-maria Vasiliadis, Dharmender Singh, Sylvie PerreaultAbstract:Background Both the 2012 Beers list and the American Geriatric Society ‘Choosing Wisely’ campaign suggest restraint in the use of sedative-Hypnotics for the treatment of insomnia in older people. Sedative Hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations.
Takuya Kojima - One of the best experts on this subject based on the ideXlab platform.
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Effects of zopiclone, triazolam, and nitrazepam on standing steadiness
Neuropsychobiology, 2016Co-Authors: Koji Tada, Yuji Sato, Teiichiro Sakai, Naoki Ueda, Kimihiro Kasamo, Takuya KojimaAbstract:We examined the effects of the nonbenzodiazepine Hypnotic zopiclone and the benzodiazepine Hypnotics triazolam and nitrazepam on standing steadiness. Eight healthy volunteers received placebo, zopiclo
Koji Tada - One of the best experts on this subject based on the ideXlab platform.
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Effects of zopiclone, triazolam, and nitrazepam on standing steadiness
Neuropsychobiology, 2016Co-Authors: Koji Tada, Yuji Sato, Teiichiro Sakai, Naoki Ueda, Kimihiro Kasamo, Takuya KojimaAbstract:We examined the effects of the nonbenzodiazepine Hypnotic zopiclone and the benzodiazepine Hypnotics triazolam and nitrazepam on standing steadiness. Eight healthy volunteers received placebo, zopiclo
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Residual effects of repeated administration of triazolam and nitrazepam in healthy volunteers.
Neuropsychobiology, 2008Co-Authors: Mari Muraoka, Koji Tada, Yoshimi Nogami, Koichi Ishikawa, Tadaaki NagoyaAbstract:The residual effects of Hypnotics were investigated with a long-acting (nitrazepam) and a short-acting (triazolam) benzodiazepine Hypnotic in 8 male volunteers. Subjects received placebo, nitrazepam 5
Joris C. Verster - One of the best experts on this subject based on the ideXlab platform.
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Effect of Hypnotic drugs on body balance and standing steadiness
Sleep Medicine Reviews, 2010Co-Authors: Monique A. J. Mets, Berend Olivier, Edmund R. Volkerts, Joris C. VersterAbstract:Summary Background Disturbed body balance and standing steadiness are problematic for those who wake up at night or in the morning after using Hypnotic drugs. As a result, falls and hip fractures are frequently reported in patients using sleep medication. Methods A literature search was performed to identify double blind, placebo-controlled clinical trials that examined body balance and standing steadiness. Drugs that were searched were nitrazepam, triazolam, lorazepam, temazepam, loprazolam, flunitrazepam, flurazepam, and the Z-drugs zopiclone, zolpidem and zaleplon. Results A total of 57 studies were eligible for inclusion. Results showed that both benzodiazepine Hypnotics and the Z-drugs significantly impair body balance and standing steadiness after single dose administration. Impairments correlate significantly with blood plasma levels and are greatest at peak plasma concentrations, but are sometimes still present upon awakening. Balance problems were dose-related and most pronounced in elderly. Co-administration of alcohol aggravated the impairment. After repeated daily use of Hypnotic drugs partial tolerance develops to the impairing effects on standing steadiness. Conclusion Single dose administration of benzodiazepine Hypnotics and Z-drugs significantly impair body balance in a dose-dependent manner. Zolpidem and zopiclone produced similar significant impairment as benzodiazepine Hypnotics. Zaleplon significantly impaired balance up to 2 h after intake. Partial tolerance develops after repeated daily use. In conclusion, patients should be warned about the possible risk of imbalance and falls due to the use of sleep medication.
A. Vermeeren - One of the best experts on this subject based on the ideXlab platform.
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On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of Hypnotics
Psychopharmacology, 2014Co-Authors: T. R. M. Leufkens, J. G. Ramaekers, A. W. Weerd, W. J. Riedel, A. VermeerenAbstract:Rationale Many older adults report sleep problems and use of Hypnotics. Several studies have shown that Hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic Hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving. Objectives The present study aimed to compare actual driving performance and driving-related skills of chronic Hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use Hypnotics and good sleepers. Methods Twenty-two frequent users of Hypnotics (using Hypnotics ≥4 nights per week for more than 3 months), 20 infrequent users (using Hypnotics ≤3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent Hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing. Results Polysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls. Conclusions Driving performance in chronic users of Hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.
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highway driving in the elderly the morning after bedtime use of Hypnotics a comparison between temazepam 20 mg zopiclone 7 5 mg and placebo
Journal of Clinical Psychopharmacology, 2009Co-Authors: Tim R M Leufkens, A. VermeerenAbstract:A major problem related to Hypnotic drug use is residual sedation the morning after bedtime administration. This constitutes a particular safety hazard for patients who have to drive a car the next morning. Information on the severity of residual effects is mainly derived from studies conducted with young healthy volunteers. However, most users of Hypnotics are older people who may be more sensitive to drug effects. The aim of this study was to evaluate the residual effects the morning after evening doses of temazepam 20 mg and zopiclone 7.5 mg on driving performance in healthy elderly drivers. Eighteen healthy elderly drivers (10 females and 8 males; mean age, 64.3 years) participated in a double-blind, 3-way crossover study. Treatments were single oral doses of temazepam 20 mg, zopiclone 7.5 mg, and placebo administered at bedtime. Subjects performed a standardized highway driving test between 10 and 11 hours after Hypnotic intake. Before and after the driving test, cognitive performance was assessed. Driving performance did not differ between temazepam and placebo but was significantly impaired after zopiclone 7.5 mg (P Language: en
