Concomitant use of sleeping pills and strong painkillers is common among people with Alzheimer’s disease

One in five people with Alzheimer’s disease (AD) who use a benzodiazepine are also concomitant users of an opioid, according to a new study from the University of Eastern Finland. Concomitant use was more common in comparison persons, but those with AD used strong opioids more frequently. About half of all concomitant users were prolonged users whose use of these drugs had continued for more than three consecutive months.

Prolonged concomitant use was associated with lung diseases, osteoporosis and previous hip fracture. In addition, a history of substance abuse and previous long-term use of benzodiazepines were related to prolonged concomitant use. In these high-risk patient groups, concomitant use of opioids and benzodiazepines or related drugs may increase the risk of pneumonia, fractures and drug misuse.

The most commonly used drug combination among persons with AD was a benzodiazepine and a weak opioid, while those without AD most commonly used a benzodiazepine related Z-drug and a weak opioid. Those with AD were more commonly prescribed strong opioids than those without AD. The trend may be partly explained by the use of opioid patches that are more commonly used in individuals with AD. In Finland, only buprenorphine and fentanyl are available as patches.

“Concomitant use of drugs that act on the central nervous system in an older population is concerning, as the use of these drugs has been associated with serious risks, especially in frail individuals with AD. Unnecessary co-use of these drugs should be avoided, as the benefits rarely outweigh the risks,” says University Lecturer Niina Karttunen from the University of Eastern Finland.

The study was part of the nationwide register-based MEDALZ study that includes all persons with clinically verified diagnosis of Alzheimer’s disease in Finland during 2005–2011. The study included 70,718 persons diagnosed with Alzheimer’s disease. Data on drug use was extracted from the Finnish Prescription Register. The study was conducted at the University of Eastern Finland and published in International Journal of Geriatric Psychiatry.

For further information, please contact:

Niina Karttunen, PhD, University of Eastern Finland, School of Pharmacy, Kuopio, Finland, niina.karttunen(at)uef.fi

Research article: 

Karttunen N, Taipale H, Hamina A, Tanskanen A, Tiihonen J, Tolppanen AM, Hartikainen S. Concomitant use of benzodiazepines and opioids in community-dwelling older people with or without Alzheimer’s disease – A nationwide register-based study in Finland, published online October 29, 2018. DOI: 10.1002/gps.5018 

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The University of Eastern Finland, UEF, is one of the largest universities in Finland. The activities of the UEF underscore multidisciplinarity, and the university is especially strong in research related to forests and the environment, health and well-being, and new technologies and materials. The UEF offers teaching in more than 100 major subjects. In addition to the high standard of teaching, the university offers its students a modern study environment, which is under constant development. The university comprises four faculties: the Philosophical Faculty, the Faculty of Science and Forestry, the Faculty of Health Sciences, and the Faculty of Social Sciences and Business Studies. The university’s campuses are located in the heart of beautiful eastern Finland in Joensuu, Kuopio and Savonlinna. The UEF is home to approximately 15 000 students and nearly 2 800 members of staff.

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