Prescrição de Benzodiazepinas e outros Sedativos na Administração Regional de Saúde de Lisboa e Vale do Tejo de 2013 a 2020: Um Estudo Retrospetivo

Samuel Gomes; Paula Broeiro-Gonçalves; Cristina Meireles; Daniel Caldeira; João Costa; Mara Pereira Guerreiro; Nadine Ribeiro; Renata Afonso

doi:10.20344/amp.18680

Authors

Samuel Gomes Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa; Unidade de Saúde Familiar Águas Livres. Amadora. Portugal. https://orcid.org/0000-0002-5134-3359
Paula Broeiro-Gonçalves Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo; Unidade de Cuidados de Saúde Primários dos Olivais; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal. https://orcid.org/0000-0002-5013-6171
Cristina Meireles Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo; Serviços Farmacêuticos. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal.
Daniel Caldeira Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo; Serviço de Cardiologia. Hospital Universitário de Santa Maria; Centro Cardiovascular. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. https://orcid.org/0000-0002-2520-5673
João Costa Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo; Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa; Instituto de Medicina Molecular de Lisboa. Lisboa. Portugal. https://orcid.org/0000-0002-5831-4921
Mara Pereira Guerreiro Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa; Egas Moniz Interdisciplinary Research Center. Egas Moniz School of Health & Science. Monte da Caparica. Portugal. https://orcid.org/0000-0001-8192-6080
Nadine Ribeiro Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa; Egas Moniz Interdisciplinary Research Center. Egas Moniz School of Health & Science. Monte da Caparica. Portugal.
Renata Afonso Comissão de Farmácia e Terapêutica. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa. Portugal.

DOI:

https://doi.org/10.20344/amp.18680

Keywords:

Benzodiazepines, Drug Utilization/trends, Hypnotics and Sedatives, Off-Label Use, Portugal, Practice Patterns, Physicians/trends

Abstract

Introduction: Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region.
Material and Methods: From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration.
Results: There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator “proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics”, was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator “proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics”, the median was 93.6 in 2019 and 94.3 in 2020.
Conclusion: There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.

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