@HealthMed: The following comments were
in response to a new paper linking use of anti-depressants, benzodiazepines and
newer sleeping medicines to increased risk of motor vehicle accidents.
These comments were part of the briefing on this paper from the Science Media Centre.
In a paper
published in the British
Journal of Clinical Pharmacology, Tsai and colleagues from Taiwan have reported
a ~40-70% relative increase in risk of non-fatal driving accidents in Taiwan
linked to prescription of a wide range of anti-depressants, benzodiazepines and
newer Z-drug sleeping medicines. In their study, around 5200 people who had had
motor accidents were compared with around 31,000 people with no history of
accidents. The medicines appeared possibly linked to from 1 in 20, to 1 in 70
accidents, depending on the drug type. Obvious questions for pharmacologists,
health professionals and the public are whether these findings are credible,
and if so, generalisable to other parts of the world.
This Taiwan
report was based on a case-control study – more open to bias than randomized
trials. Although the researchers matched controls for age, gender and year of
the accidents, they were unable to rule out differences in patterns of driving
or in alcohol
intake between the groups. Alcohol amplifies any impairment in
concentration resulting from effects of drugs that act on the brain; and ethnic
Taiwanese are commonly are intolerant of alcohol, due to genetic lack of the
enzyme needed to break down alcohol.
It is also
possible that the increased accident risk resulted from effects of underlying
psychological or psychiatric disorders for which the drugs were prescribed e.g.
through poorer concentration or indirectly through additional effects of sleep
disturbance caused by the conditions under treatment, independent of the
drugs. In addition the researchers noted that those who had accidents also had a
higher burden of a range of non-psychiatric diseases, also recognized as
increasing risk of accidents.
What do these
results mean for populations in other countries? Several of the drugs implicated in Taiwan
are not commonly used in other countries and there are several sources of bias indicating need
for caution in interpreting the study. However other studies have stressed the
need for caution when driving when using these types drugs. When these drugs
are prescribed, patients should seek advice about risks of driving from their
physician or pharmacist. In any event, patients on these drugs should avoid any
alcohol when driving.
More information: Chia-Ming Chang and colleagues. Psychotropic Drugs and Risk of Motor Vehicle
Accidents: a Population-based Case-Control Study; British Journal of Clinical
Pharmacology; DOI: 10.1111/j.1365-2125.2012.04410.x
Prevalence
of alcohol and other drugs in fatally injured drivers. Joanne E.
Brady, Guohua Li. Addiction.
Published online August 20, 2012
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