Failure to limit quantities of benzodiazepine hypnotic drugs for outpatients: placing the elderly at risk.
OBJECTIVE
The long-term use of benzodiazepine hypnotics by the elderly is associated with serious side effects, and prescriptions of large quantities of these agents allow such use. Therefore, we determined the quantities of these agents prescribed to outpatients in our Veterans Administration teaching hospital, and the relationship of patient age to total number of doses prescribed per prescription.


METHODS
Pharmacy and patient records related to 655 consecutive prescriptions for triazolam (Halcion) and flurazepam (Dalmane) were reviewed. Only 266 (41%) of the prescriptions were for 30 or fewer doses, while 178 (27%) were written for 180 or more doses.


RESULTS
Thirty-six percent of prescriptions for patients aged 65 years or older were for 180 or more doses, compared with 24% for those aged 45 to 64 years old, and 16% of the prescriptions for patients less than 45 years old (p less than 0.0001). In a multivariate analysis controlling for six other factors related to the total number of doses prescribed, patients aged 65 years or older were still more likely to receive a prescription for 180 or more doses (relative risk 1.9, 95% confidence interval 1.3, 2.8).


CONCLUSIONS
We conclude that inappropriately large quantities of benzodiazepine hypnotics were commonly prescribed, and that patients aged 65 years or older were at greatest risk for receiving such prescriptions.
Shorr
R I
RI
Department of Medicine, University Hospital of Cleveland, Ohio.
Bauwens
S F
SF
Landefeld
C S
CS
D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005479:Flurazepam / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000503:physiopathology; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology; D009820:Ohio / Q000453:epidemiology; D010820:Physicians; D011570:Psychiatry; D012307:Risk Factors; D014229:Triazolam / Q000008:administration & dosage*
D014229:Triazolam; D005479:Flurazepam