title: Comorbidities and concurrent medications increasing the risk of adverse drug reactions: prevalence in French benzodiazepine users.
abstract: OBJECTIVE
  To estimate benzodiazepine prevalence of use and to quantify, in benzodiazepine users, the prevalence of comorbidities and concurrent medications increasing the risk of adverse drug reactions (ADRs).
  
  
  METHODS
  Cross-sectional study performed using data from the French national healthcare insurance system. The prevalence of use was estimated by considering as users, patients who had at least one benzodiazepine reimbursement during the year 2013. Patients at increased risk for benzodiazepine ADRs were those who had (i) drug-drug interactions at risk for central nervous system and respiratory depression and (ii) comorbidities at risk for adverse respiratory effects, or for falls or fractures.
  
  
  RESULTS
  Overall, the prevalence of benzodiazepine use in 2013 was estimated to be 13.8 %; it was higher among women and increased with age. This prevalence was 10.6 % for anxiolytic benzodiazepines, and 6.1 % for hypnotic benzodiazepines. Approximately half of the benzodiazepine users (48.1 %) were at increased risk for benzodiazepine ADRs; this proportion increased with age. Drug-drug interactions represented the most prevalent condition (39.3 % of benzodiazepine users). The drugs most frequently involved were opioids: analgesics (15.9 %) and antitussives (6.8 %). Overall, 11.3 % of benzodiazepine users had comorbidities at increased risk for adverse respiratory effects (13.9 % in those aged 65-79), and 7.0 % comorbidities at increased risk for falls or fractures (13.4 % in those aged ≥80).
  
  
  CONCLUSIONS
  This study found that benzodiazepine use remained high in France, and that roughly half of the users presented with comorbidities and concurrent medications increasing the risk of ADRs. These findings are of concern, given that benzodiazepines are frequently used, and especially among the elderly.
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France. anne.benard@u-bordeaux.fr.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France. anne.benard@u-bordeaux.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Bénard-Laribière
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.|CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors.forename: Pernelle
authors.initials: P
authors.lastname: Noize
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Pambrun
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Bazin
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.|Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Verdoux
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.|Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Tournier
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.|CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bégaud
authors.affiliation: University of Bordeaux, U1219, F-33000, Bordeaux, France.|INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.|CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Pariente
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects*; D002493:Central Nervous System Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004347:Drug Interactions; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D015995:Prevalence; D012120:Respiration Disorders / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Benzodiazepines; Drug utilization; Insurance health reimbursement; Pharmacoepidemiology