The use of sedative/hypnotic medication and its correlation with falling down in the hospital

The relationship between reports of falling down and the administration of sedative/hypnotics or other psychotropic drugs was examined during a 1-year period in a 1,000-bed teaching hospital. It was found that patients who fell were approximately 2.7 times as likely to have received a psychotropic drug compared to control subjects matched for age, gender, and medical service. Orally administered benzodiazepines that were significantly associated with falls included temazepam, alprazolam, diazepam, and lorazepam, but not triazolam, chlordiazepoxide, or chlorazepate. When viewed as the frequency of falls per dose dispensed by the pharmacy, the highest rates were with lorazepam (0.0012 falls/dose) and alprazolam (0.0010 falls/dose), whereas the lowest rate was for diazepam (0.00052 falls/dose). Falls with antidepressants were comparable to the higher rates with benzodiazepines; frequencies for nortriptyline and sertraline were 0.0021 and 0.0012 falls/dose, respectively. Patients receiving two or three psychotropic drugs concomitantly were 3.7 and 9.5 times, respectively, more likely to fall compared to control subjects. Patients under 21 years old who fell were also significantly more likely to have received a psychotropic medication compared to control subjects. Although these data are associational and do not necessarily imply causality, prudence indicates that the risk of falls be considered in making benefit/risk decisions about prescribing sedative/hypnotics.