title: Pain medication in German nursing homes: a whole lot of metamizole.
abstract: Prescribing of metamizole (dipyrone), an analgesic that has been withdrawn from the market or never approved in many countries owing to safety concerns, is high in elder persons in Germany. This study assessed the use of pain medications in German nursing homes with a special focus on prescribing patterns of metamizole.
  
  
  
  Using data of the 'Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes' (IMREN) study conducted between October 2014 and April 2015 in nursing homes in Bremen and Lower Saxony, we studied prescribing of analgesics including both scheduled and as-needed medications. For residents with scheduled medication, dosage and duration of use were analysed.
  
  
  
  A total of 852 residents from 21 nursing homes were included. They were on average 83.5 years old, and 76.5% were women; 73.8% received at least one analgesic with 70.3% obtaining World Health Organization step I drugs. The most frequently prescribed substances were metamizole (for 40.6%) and paracetamol (acetaminophen; 35.6%), with paracetamol given mostly as-needed. The proportion of residents receiving metamizole increased with age (up to 47.4% in persons aged 90 years and over). Of 143 residents with scheduled metamizole (16.8%), the mean daily dosage was 1843 mg (interquartile range [IQR]: 1500-2250); 66.9% received metamizole for at least 90 days and 23.2% for at least 365 days (mean duration 276 days; IQR: 59-314).
  
  
  
  There is a discrepancy between prescribing of metamizole for older persons, on the one hand, and evidence on comparative effectiveness and safety as well as approval and recommendations, on the other hand. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.affiliation: Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.|Health Sciences Bremen, University of Bremen, Bremen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004177:Dipyrone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005858:Germany; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D004177:Dipyrone
keywords: Germany; analgesics; dipyrone; health services research; nursing homes; pharmacoepidemiology