Secular Trends in Central Nervous System-Active Polypharmacy Among Serial Cross-Sections of US Adults, 2009–2020

Background Data comprehensively examining trends in central nervous system (CNS)-active polypharmacy are limited. The objective of this cross-sectional study was to characterize the composition of and trends in CNS-active medication use in US adults. Methods We included all participants ≥ 18 years old in the National Health and Nutrition Examination Study (NHANES), 2009–2020. The primary outcome was the percent of adults with CNS-active polypharmacy. This was defined as ≥ 3 medications among antidepressants [tricyclic, selective and serotonin–norepinephrine reuptake inhibitors (SSRIs and SNRIs), opioids, antiepileptics, antipsychotics, benzodiazepines, and nonbenzodiazepine receptor agonists (“Z-drugs”)]. Secondary outcomes included prevalence of any CNS-active medication and specific medications and classes over time, and their indications. Percentages were weighted according to NHANES’s nationally representative sampling frame. log binomial regressions evaluated the relative risk (RR) for each outcome, comparing the last (2017–2020) versus the first (2010–2011) survey cycle. Results We included 34,189 adults (18.8% at least 65 years old) from five serial cross-sections (survey cycles). The prevalence of CNS-active polypharmacy was 2.1% in 2009–2010 and 2.6% in 2017–2020 [RR 1.18, 95% confidence interval (CI) 0.94–1.47]. The prevalence of CNS-active polypharmacy did not significantly change within any specific age group (e.g., age at least 65 years: RR 1.29, CI 0.74–2.24). The prevalence of any CNS-active medication was 21.0% in 2009 and 24.6% in 2017–2020 (RR] 1.12, 95% CI 1.02–1.25). A substantial increase occurred for antiepileptics (5.1–8.3%), specifically among participants aged 65 years and older (8.3–13.7%). This was largely driven by increasing gabapentin prevalence (1.4–3.6% overall; 3.3–7.9% age 65 years and older). Anticholinergic, SSRIs/SNRIs, antiepileptics, and benzodiazepines were elevated in most cycles for participants at least 65 years old compared with participants less than 65 years, and opioid use was increased in several cycles for older participants as well. Alprazolam was the most common benzodiazepine and third most common medication for anxiety/depression. Gabapentin was the most common CNS-active medication (3.6% of all participants in 2017–2020), followed by sertraline, citalopram, and acetaminophen-hydrocodone (each ~2%). The most common categories were antidepressants (13.7% in 2017–2020), followed by opioids (5.1% in 2017–2020). Conclusions CNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults..

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:40
Enthalten in:	Drugs & aging - 40(2023), 10 vom: 11. Sept., Seite 941-951

Sprache:	Englisch

Beteiligte Personen:	Terman, Samuel W. [VerfasserIn] Niznik, Joshua D. [VerfasserIn] Growdon, Matthew E. [VerfasserIn] Gerlach, Lauren B. [VerfasserIn] Burke, James F. [VerfasserIn]

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© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:	10.1007/s40266-023-01066-w

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PPN (Katalog-ID):	OLC2145658963