Do trazodone and zopiclone have similar safety in nursing home residents?

Older adults living in nursing homes often experience sleep disturbances and agitation. These symptoms are often treated with antipsychotics, antidepressants, benzodiazepines and nonbenzodiazepines sedative-hypnotics (e.g., zopiclone). Although usage of antipsychotics and benzodiazepines in older adults has stabilized or declined in recent years, the use of alternate psychotropic medications has increased. Growing evidence describes the risk of falls and fractures in older adults who are dispensed trazodone or nonbenzodiazepine sedative hypnotics (e.g., zopiclone). However, these drugs continue to be commonly used in nursing home residents and their comparative risk of harm is unknown. A study of older adults living in nursing homes in Alberta was conducted to determine the risk of harm from injurious falls, fractures and death associated with new use of zopiclone compared to new use of trazodone. The retrospective cohort study enrolled 3,002 older ( ≥ 66 years of age) nursing home residents living in Alberta between Dec. 1, 2009, and Dec. 31, 2018, with follow-up until mid-2019. The investigators compared the rate of injurious falls and major osteoporotic fractures (primary outcome) and all-cause mortality (secondary outcome) within 180 days of first prescription of zopiclone or trazodone. Read: Results showed the following: The study included 1,403 residents newly dispensed trazodone and 1,599 residents newly dispensed zopiclone (resident mean age 85.7; 61.6% female; 81.2% with dementia). The median total daily doses were zopiclone 7.5 mg and trazodone 25 mg. Compared to trazodone, new zopiclone use was associated with similar rates of injurious falls and major osteoporotic fractures (intention-to-treat-weighted hazard ratio 1.15, 95% confidence interval [CI] 0.90–1.48); and all-cause mortality (intention-to-treat-weighted hazard ratio 0.96, 95% CI 0.79–1.16). These study findings provide direct estimates of the comparative risk of harm associated with trazodone or zopiclone use in nursing home residents. The authors conclude that zopiclone is associated with a similar rate of injurious falls, major osteoporotic fractures and all-cause mortality compared with trazodone. This suggests that one medication should not be used instead of the other, and deprescribing initiatives in nursing homes should target inappropriate prescribing of zopiclone and trazodone, in addition to antipsychotics and benzodiazepines. The authors suggest that nursing homes should establish an interprofessional team responsible for psychotropic medication stewardship, develop psychotropic medication appropriateness criteria, educate care staff about these policies, and inform and involve family and friend carers in these initiatives. Nursing homes should also establish a regular medication review process, with discontinuation of potentially inappropriate medications. Nonpharmacologic interventions should be made available, to ensure that inappropriate administration of psychotropic medications is minimized. Reference 1. Watt JA, Bronskill SE, Lin M, et al. Comparative risk of harm associated with zopiclone or trazodone use in nursing home residents: a retrospective cohort study in Alberta, Canada. Can Geriatr J 2023;26(1):9-22. (accessed March 21, 2023).

Do trazodone and zopiclone have similar safety in nursing home residents?

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