Anxiety drugs and antidepressants trigger post-surgery delirium, study
finds

Date:
December 8, 2021
Source:
University of South Australia
Summary:
A new study finds that older people taking a drug used to
treat anxiety and insomnia -- nitrazepam -- as well as those
on antidepressants, are twice as likely to suffer postoperative
delirium after hip and knee surgery.



FULL STORY ========================================================================== Older people taking a drug used to treat anxiety and insomnia --
nitrazepam - - as well as those on antidepressants, are twice as likely
to suffer postoperative delirium after hip and knee surgery, a new
Australian study has found.


==========================================================================
The finding has prompted calls by University of South Australia (UniSA) researchers for older patients to temporarily cease these medications
or change to safer alternatives prior to surgery.

In a study published in the international journal Drug Safety, UniSA
scientists scanned data from 10,456 patients aged 65 years and older who
had undergone knee or hip surgery in the past 20 years. A quarter of them
(2614 people) had experienced delirium after surgery.

Apart from nitrazepam and antidepressants, five other benzodiazepine medications -- commonly prescribed for anxiety, seizures and insomnia --
were associated with delirium, although not to the same extent. They
included sertraline, mirtazapine, venlafaxine, citalopram and fluvoxamine.

Lead researcher Dr Gizat Kassie says there was no link between
pain-relieving opioids and delirium.

"Our findings show that different classes of medicine are riskier than
others when it comes to causing delirium after surgery, and the older
the patients are, the greater the risk," he says.



========================================================================== Smoking, alcohol use, multiple health conditions, polypharmacy (taking
five or more medications), psychoactive drugs and impaired cognition
also put people at risk.

"Many of these factors can't be altered but we can do something about medications," Dr Kassie says.

Delirium affects up to 55 per cent of older patients undergoing hip
surgery and is associated with an increased risk of death, prolonged
hospital stays and cognitive decline.

An earlier study found that older people who developed delirium following
hip surgery had a 10 per cent higher death rate within one year compared
to patients who were not affected.

The UniSA study is the first to investigate the link between specific medications and dementia after surgery. Previous studies have been
broader in scope, considering a range of factors predisposing older
patients to delirium.

The researchers hope that evidence-based recommendations can be
implemented into clinical practice so that delirium risk by medicine
type can be determined.

"In people undergoing elective procedures it should be practical to
taper specific medications well in advance. It's important that people
are weaned off these riskier drugs well before surgery because abrupt withdrawal can have even worse consequences," Dr Kassie says.

========================================================================== Story Source: Materials provided by University_of_South_Australia. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Gizat M. Kassie, Elizabeth E. Roughead, Tuan A. Nguyen, Nicole
L. Pratt,
Lisa M. Kalisch Ellett. The Risk of Preoperative Central Nervous
System- Acting Medications on Delirium Following Hip or Knee
Surgery: A Matched Case-Control Study. Drug Safety, 2021; DOI:
10.1007/s40264-021-01136-1 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211208102600.htm

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