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Sedating antihistamines often prescribed inappropriately for older adults with insomnia

Wednesday, May 09 2007 | Comments

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What's This? Despite the fact that antihistamines are considered inappropriate for treating elderly patients with insomnia, they are commonly prescribed for this use, a retrospective cohort study found.

Using national Veterans Affairs data, researchers identified patients aged 65 years or older who were prescribed an antihistamine during >=1 outpatient clinic visit in fiscal year 1999 or 2000. Researchers then examined the directions for use for each sedating antihistamine prescribed. They classified the reasons for prescribing into 5 categories: definite/probable insomnia, allergy/pruritus, psychiatric conditions, unclear (but probably not for sleep), or missing/unusual.

The investigators found that, of 1,096,361 outpatients, 87,709 (8%) were prescribed a potentially inappropriate antihistamine. Of the 150,000 directions for use that were coded, only 16% were for allergies/pruritis or other uses considered by an expert panel to be appropriate. Potentially inappropriate uses were seen 44% of the time for definite/probable sleep, 37% of the time for vague reasons (but not likely for sleep), and 2% of the time for psychiatric uses. Additionally, 0.5% of the time the reason was not given or was unusual.

According to lead study author Dr. Monica Horton, an assistant professor of geriatrics at the University of Texas Health Science Center at San Antonio, the reason antihistamines are prescribed for older adults with insomnia, despite their risks, is that they are "cheap, available over the counter, and they work." However, physicians need to weigh the risks associated with these drugs (such as confusion and falls) against their benefits, she told VerusMed. Dr. Horton noted that safer and nonpharmacologic insomnia treatments are available and should be used instead of antihistamines.

Dr. Horton recommended that further research be conducted to analyze the outcomes of using antihistamines in this patient population. (Poster B55.)

This information may concern uses that have not been approved by the Food and Drug Administration.

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