慢性期病院における転倒・転落に与える睡眠薬切り替えの効果と作用機序別リスク評価

抄録

One of the adverse effects of benzodiazepine receptor agonists is the high risk of falls. In particular, in elderly people, physiological functions are decreased, so that excessive sedation, muscle relaxation, and carry-over effects often occur; thus, the risk of fall accidents increases. In recent years, sleeping medications with new mechanisms of action, ramelteon and suvorexant, have been launched. The impact of these medicines on fall accidents has not been clarified. Between 2015 and 2018, in-hospital prescriptions for sleeping pills were switched from benzodiazepine receptor agonists to drugs with the new mechanisms of action in our hospital. Subsequently, we evaluated the fall risk by drug mechanism. The number of fall accidents followed an upward trend in 2015, 2016 and 2017 shortly after the switching process started, and followed a downward trend in 2018, when the prescription of benzodiazepine receptor agonists decreased. In contrast, it was shown that the risk of falling with suvorexant was equivalent to that with benzodiazepine receptor agonists. Because confounding factors were not excluded, clear evidence was not obtained, but it is suggested that for patients administered suvorexant, similar to benzodiazepine receptor agonists, the risk of falls should be considered.