By The CMAJ


An elderly person uses a walker to help pull herself up after falling

As physicians attempt to decrease antipsychotic use in seniors with dementia, they need to be aware that trazadone, frequently used as an alternative, has similar risks of falls and major fractures compared with atypical antipsychotics, according to new research in CMAJ (Canadian Medical Association Journal).

“As clinicians move to decrease antipsychotic use, we should not consider trazadone as a uniformly safer alternative to atypical antipsychotics, because trazadone use was associated with a comparable risk of falls and major osteoporotic fractures to atypical antipsychotics – drugs associated with these adverse outcomes in our patient population,” writes Dr. Jennifer Watt, St. Michael’s Hospital, Toronto, Ontario, with coauthors.

The rate of dementia in Canada is 7% but almost 25% in people over age 85. In long-term care facilities, 62% of residents have dementia and many exhibit aggressive behaviour. Although evidence is limited on efficacy, antipsychotics and trazadone, an antidepressant also used for sleep issues, are commonly prescribed for patients with dementia.

Using linked data from the Institute of Clinical Evaluative Sciences (ICES), researchers looked at data on 6,588 seniors newly dispensed trazadone and 2,875 newly dispensed an antipsychotic. They found that patients dispensed trazadone had a rate of falls and major fractures, including hip fractures similar to the group receiving atypical antipsychotics. However, trazadone was associated with a lower risk of death in patients.

“We hope this information can be used to inform conversations that patients and caregivers are having with clinicians about the benefits and risks of different treatment options,” writes Dr. Watt.


These papers are an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.