Opioid analgesics, Z-drugs linked to harmful effects in dementia patients

The research, presented at the Alzheimer’s Association International Conference (AAIC), looked at the impact of opioid-based painkillers and a class of sleep medication known as Z drugs (zolpidem, zopiclone and zaleplon), which are prescribed to an estimated 200,000 with dementia living in care homes across the UK.

The researchers, from the University of Exeter, King’s College London and the University of Bergen, found a tripling in harmful side effects - such as personality changes, confusion and sedation - related to the use buprenorphine in people with dementia, compared to those on a placebo.

The research - carried out in Norway - also found that those patients given buprenorphine were significantly less active during the day.

"It is essential that people living with dementia are given as much help as possible to manage chronic pain, but this research suggests they may be particularly susceptible to harmful side-effects of common opioid-based painkillers," said Dr Laura Phipps from Alzheimer’s Research UK, commenting on the results.

"The findings are concerning as underlying pain can be a significant contributor to distress in people with dementia, who are not always able to communicate their needs to those around them.

"Following this study, researchers need to explore whether tailoring dosages of painkillers for people with dementia could limit their side-effects while retaining their important benefits."

In the Z-drugs research, undertaken in the UK, the team compared data for 2,952 people with dementia who were newly prescribed the medication with data for 1,651 who were not.

They found that these sleeping drugs increased the likelihood of bone fractures occurring by 40 percent, while 59 percent of patients were more likely to have broken a hip and 34 percent were more likely to have died in the following two years.

Researchers are now calling for studies to assess alternative non-drug approaches to treating pain and insomnia, and appropriate dosing of painkillers such as buprenorphine for people with dementia.

"Research into antipsychotics highlighted that they increased harmful side effects and death rates in people with dementia. This compelling evidence base helped persuade everyone involved in the field to take action, from policy makers to clinicians, reducing prescribing by 50 per cent," said Clive Ballard,

"We now urgently need a similar concerted approach to opioid-based painkillers and Z-drugs, to protect frail elderly people with dementia from fractures and increased risk of death."

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