Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 19
3
~ 2
00
I
S
SN
: 225
2-8
8
0
6
1
93
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
The P
r
eval
ence of Alprazol
am Us
es in Geriat
ri
c P
a
tient
s
at
Dr. M
o
hammad Hoesin Hospit
al
Pal
e
mbang
Yohanes Fe
br
ianto
1
, Sutom
o
T
a
nz
il
2
, Theodorus
Par
u
lian
2
1
Facult
y
of Med
i
cine
, Gen
e
ra
l Pr
act
ition
e
r,
Sriwij
a
y
a Univ
ersit
y
,
Palem
b
ang,
Indo
nesia
2
Departm
e
nt of P
h
arm
acolog
y
,
F
acult
y of
Med
i
cine, Sriwijay
a
University
, Indo
nesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Dec 15, 2015
Rev
i
sed
Feb
27
, 20
16
Accepted Apr 02, 2016
One of the m
o
s
t
frequent
l
y
pr
es
cribed
drugs
in geriatri
c pa
ti
ents is a
benzodi
azep
ine
,
es
peci
all
y
a
s
hor
t-ac
ting
s
u
ch as
alpra
z
olam
.
Unf
o
rtunat
e
l
y
,
alprazolam is o
f
tenly
used
inappropr
iately
b
e
cause this drug
has a shor
t
act
ing effe
ct
. Ge
riatr
i
c pa
tien
t
s ar
e m
o
re sensitive
to this drug tha
t
can l
ead to
the dep
e
ndenc
e.
However, ther
e i
s
still la
ck of dat
a
on the use of t
h
is drug in
geria
t
ric p
a
ti
ents
. The aim
of thi
s
s
t
udy
was
to d
e
term
ine th
e pre
v
alen
ce of
the use of alprazolam
. A drug u
tili
zat
ion stud
y
has been done for 2 m
onths
through analy
s
is of patient’s medical reco
rds in
th
e internal medicine ward at
RSMH
Palembang from June 1
st
, 2012 to May
3
1
st
, 2013.
There
were 25 out
of 1634 patients
receiv
i
ng alpra
z
o
lam
,
but
onl
y
2
3
patients whose data were
obtain
e
d from
t
h
e av
ail
a
ble
m
e
dica
l re
cords
.
P
r
eval
ence
of
alpr
azol
a
m
us
e
was 1.408%. Based on gender, the prev
alen
ce
was 1.798% in
female and
1.09% in male p
a
tients. Proportion b
y
age group
was 91.3%, 8.7
%
and 0% in
age group 60-74
y
e
ars, 75-90
y
e
ars and ove
r 90
y
e
ars, respectively
. Based on
the job, th
e population stud
y comprised of the housewive (52.1%)
,
unemplo
y
m
ent (
39.1%), and
entrepreneur
and f
a
rmer (4.3% tog
e
ther)
.
The
indication of
usage was ath
e
roscerot
ic he
a
r
t dis
eas
e
,
dia
rrhoea and
gastroent
e
rit
i
s
of presum
ed i
n
fect
ious origin
, unspec
i
fied
g
a
stritis
, and
th
y
r
o
t
oxic heart disease. In oth
e
r words, it cou
l
d be said that the usage o
f
alprazolam was
inappropriate.
Keyword:
Alprazolam
Dr
ug
Geriatric patients
Medical rec
o
rds
Pre
v
alence
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Yo
ha
nes F
e
b
r
i
a
nt
o,
Facu
lty of Med
i
cin
e
,
Gen
e
ral
Practitio
n
e
r,
Sriwi
j
aya Un
iversity,
Jl
. D
r
. M
o
h
a
m
m
a
d Al
i
K
o
m
p
l
e
k R
S
M
H
K
M
3.
5,
Pal
e
m
b
ang
,
30
1
2
6
,
In
do
nesi
a.
Em
a
il: Yo
h_
02_
bo
yzz@yah
o
o
.
co
.id
1.
INTRODUCTION
Agi
ng i
s
defi
n
e
d as a
pr
ocess
t
h
at
t
r
ans
f
o
r
m
s
an a
dul
t
i
n
t
o
a weak
pe
rso
n
by
re
duci
ng i
n
m
o
st
of t
h
e
p
h
y
si
o
l
og
ical syste
m
b
ack
up
and
in
creased
suscep
tib
ility
to
v
a
riou
s
d
i
seases an
d
d
eath
[1
]. C
h
an
g
e
i
n
r
e
spon
se to
some d
r
ug
o
c
cu
rs w
ith
increas
e of age i
n
many pe
ople. Ph
arm
acologica
l changes in geriatric
p
a
tien
t
s su
ch as ch
ang
e
s in the m
ech
an
is
m
o
f
ab
sorp
tio
n,
distrib
u
tion
,
m
e
tab
o
lism
,
an
d
eli
m
in
atio
n
o
f
d
r
ug
s.
Patterns of drug
use are also cha
nge
due
to the incr
easi
ng inci
dence
of disease accordi
ng to age a
nd the
t
e
nde
ncy
fo
r d
o
ct
o
r
s t
o
p
r
esc
r
i
b
e exce
ssi
ve
dr
u
g
s f
o
r
pat
i
e
nt
s i
n
n
u
rsi
ng
hom
es [2]
.
O
n
e of d
r
ug t
y
pe
t
h
at
i
s
ofte
n
used in t
h
e elde
rly is a
group be
nz
odi
azepine
[3].
Data from
The Drug
Abuse
Warnin
g Net
w
ork (DAWN)
found that op
ioi
d
s and
benz
odiazepines a
r
e
the two
drugs that m
o
st frequently repo
rted
in cases of drug
abuse [4]. Be
nzodiazepi
n
es
are often m
i
sused a
s
a result of their sedation effe
ct
m
a
inly
in the short-acting
be
nzodiazepi
n
e s
u
ch as al
praz
ol
a
m
. Alpraz
ola
m
is
a
m
e
di
cat
i
on use
d
f
o
r t
h
e sh
ort
t
e
rm
t
r
eatm
e
nt of a
nxi
et
y
an
d
pani
c
di
so
rde
r
. Thi
s
dr
ug i
s
n
o
t
recom
m
end
e
d as
first-line beca
use of the ris
k
of depe
nde
n
ce and the
pot
en
tiatio
n
fo
r m
i
su
se [5
]. Besid
e
that, alp
r
azo
lam
h
a
s a
rapi
d
onset
a
n
d
t
h
i
s
m
e
di
cat
i
on i
s
cl
assi
fi
e
d
a
s
a
hi
g
h
pot
e
n
c
y
dr
u
g
[
6
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
16:
1
9
3
– 20
0
19
4
Alprazolam
,
clonaze
pam
,
diazepam
, and lorazepam
ar
e four types of be
nz
odiaze
pines
we
re rec
o
rde
d
as 200 drugs t
h
at are m
o
st freque
n
tly u
s
ed in
U
S
A
[7
],
[8
].
Meanw
h
ile
, th
e Nation
a
l Fo
ren
s
ic Lab
o
rato
ry
Syste
m
(NFLIS) sai
d
th
at t
h
ere
was an
in
crease in
t
h
e
u
s
e
of alprazo
lam
by 7
5
% fro
m
2
0
0
1
un
til 20
05
[9
].
The
sh
ort
act
i
n
g e
ffect
,
hi
gh
pot
e
n
t
i
a
l
an
d s
h
o
r
t
hal
f-
life
of
alpraz
olam allows
u
s
ers to
co
n
tinuo
usly
use t
h
i
s
dr
ug e
v
en
o
u
t
s
i
d
e
of
t
h
e t
r
eat
m
e
nt
due t
o
t
h
e
occ
u
rrence
of de
pende
nce. Besi
de that, alpraz
ol
a
m
is
o
f
ten
p
r
escrib
ed
in
app
r
op
riat
ely an
d ou
tside of th
e in
dica
tions. The
s
e
drugs i
n
clud
ed
in the
Beer’s
criteria
2012 of Pottentially
Inappropriate Prescri
p
tions fo
r Elde
rly because there is
hi
gh i
n
cidence
of improper
adm
i
nistration of al
praz
olam
. The
use
of al
prazolam
incr
eased
in eld
e
rly
p
a
tien
t
s related to
th
e
p
r
ob
lem
th
at
oft
e
n enco
u
n
t
e
red i
n
el
de
rl
y
such as sl
eep di
st
u
r
ba
nc
e and an
xi
et
y
.
Dat
a
from
epi
d
em
i
o
l
ogi
c
a
l
and
ex
p
e
rim
e
n
t
al s
t
u
d
i
es m
e
n
tio
n
e
d
th
at th
e eld
e
rlys are
m
o
re sen
s
itiv
e to
th
e cen
tral n
e
rv
ou
s syste
m
effects of
benz
odiazepi
n
e [10]. This state
m
ent i
ndicates that the benefit of BZ
D
us
e in the elderly is still unclear.
C
u
m
m
i
ng et
al
., (2
0
0
3
)
[
1
1]
concl
udi
ng t
h
at
be
nzo
d
i
a
z
e
pi
ne
presc
r
i
p
t
i
on s
h
o
u
l
d
be
l
i
m
i
t
e
d i
n
geri
at
ri
c
pat
i
e
nt
s an
d t
h
e el
derl
y
w
h
o
have
bee
n
t
a
ki
ng t
h
i
s
dr
ug
sh
oul
d st
art
t
r
y
i
n
g
t
o
re
duce t
h
e
usa
g
e
un
der
h
o
spi
t
a
l
su
perv
ision
.
B
a
sed o
n
t
h
e
dat
a
ab
ove
, t
h
e st
udy
ai
m
was t
o
determine the preval
ence
of alpraz
olam
use to
g
e
riatric
p
a
tients at th
e Gen
e
ral Ho
sp
ital Mo
h
a
mm
ad
Ho
esin
Palem
b
an
g o
n
Jun
e
1
st
,
20
12-
May 31
st
, 2
013
peri
od to
prove the truth of
the rea
lity because there is tende
ncy of al
praz
olam
inapprop
riate presc
r
iption
accori
ng to the
Beers criteria in 2012 and the de
pende
n
ce
effets of the use of these drugs in the long term
treatm
e
nt.
2.
R
E
SEARC
H M
ETHOD
The st
udy
pr
ot
ocol
has a
p
pr
o
v
ed
by
et
hi
cal
com
m
ittee of medical faculty of
Sriwi
j
aya Uni
v
ersity.
Th
is
research
was con
d
u
c
ted at th
e
Gen
e
ral Hosp
ita
l of
Mu
h
a
mm
ad
Ho
esin Palem
b
an
g, Sou
t
h
Sumatera,
I
ndo
n
e
sia
fo
r
2 m
o
n
t
h
s
thr
ough
an
alysis of
med
i
cal r
e
co
rd
s
o
f
p
a
tien
t
s ag
ed
>
60
year
s as th
e
p
opu
latio
n who
ar
e ho
sp
italized
in
in
tern
al med
i
cin
e
w
a
rds A
to
F on
1
Ju
ne 20
12
–
31
May 2
0
1
3
per
i
od
. Patien
t
med
i
cal
records wh
ich
h
a
v
e
un
clear
in
form
at
io
n
o
r
illeg
i
b
l
e are ex
clu
d
e
d
fro
m
th
is research
.
There
was 1
6
3
4
geri
at
ri
c i
n
p
a
t
i
e
nt
whi
c
h f
o
u
n
d
t
h
r
o
u
g
h
com
put
eri
zed
sy
st
em
of R
S
M
H
i
npat
i
e
nt
medical record. T
h
e
n
, t
h
rough
phar
m
acy com
puterized syste
m
we s
earch
for t
h
e
patient who receive
d
al
praz
ol
am
dur
i
ng t
r
eat
m
e
nt
.
We en
ter t
h
e patien
t
's
med
i
ca
l r
ecord num
b
er to com
puter
and
we
get
pat
i
ent
pha
rm
acy
dat
a
d
u
ri
n
g
hos
pitalization. Through the
s
e searc
h
es, we
found 25 geri
atric
patients
who
receive
al
praz
olam
. The
n
,
we
l
o
o
k
f
o
r t
h
e pa
t
i
e
nt
’s m
e
di
cal reco
rds
o
f
pat
i
e
nt
s w
ho
ha
d b
een i
d
e
n
t
i
f
i
e
d i
n
t
h
e m
e
di
cal
recor
d
com
put
e
r
i
zed
syste
m
. Howe
ver, after a
sea
r
ch t
h
ro
u
g
h
m
e
di
cal
reco
r
d
s,
t
w
o
dat
a
are
not
fo
u
nd s
o
t
h
ere a
r
e
onl
y
23
dat
a
whic
h
we
use i
n
this
resea
r
ch
as a s
u
bject.
Medical records are t
h
en st
udied to
m
a
tch
th
e co
m
p
u
t
erized
search
results with
th
e orig
in
al d
a
ta,
th
en
we reco
rd
ed
all p
a
tien
t
d
a
ta th
at
are
neede
d
,
partic
ularly varia
b
le
in this study
that are age,
gende
r,
occupation, i
n
dications
, and side ef
fects of treatm
e
nt. Then, the
data
obtaine
d a
r
e i
n
cluded in the
SPSS
syste
m
to
facili
tate th
e read
ing
o
f
d
a
ta. Th
e
resu
lts in
th
is study are presented in the
fo
rm
of t
a
bl
es an
d g
r
ap
hs
with
th
e n
a
rrati
v
e
.
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
From
1
6
3
4
ge
ri
at
ri
c pat
i
e
nt
s
,
t
h
e m
a
jo
ri
t
y
of
h
o
sp
italized
p
a
tien
t
s were
in
th
e ag
e
g
r
ou
p of
60
-74
year
s (1
365
/83.5
%
)
.
Th
e t
o
tal o
f
911
p
a
tien
t
s w
e
r
e
m
a
le (
5
5
.
7
%
) and
t
h
e
r
e
m
a
in
in
g
723 p
a
tien
t
s ar
e f
e
male
(4
4.
2%
). P
o
p
u
l
a
t
i
on’s
s
o
ci
o
d
e
m
ograp
hi
c dat
a
can
be
seen
i
n
Ta
bl
e
1.
Fig
u
re
1
.
Ho
spitalized
Patien
t
s in
Each
of
Ward
0
20
0
40
0
H
o
sp
it
a
lize
d
P
a
ti
en
ts
Da
t
a
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
The
Preval
e
nc
e of
Al
pra
z
ol
a
m
Uses i
n
Geri
at
ri
c Pat
i
e
nt
s
at
Dr
. M
o
ha
m
m
a
d
H
o
esi
n
..
..
(
Y
oh
a
n
es
Feb
r
i
ant
o)
19
5
From
the 1634 patients, there were
23
patients who
received alprazolam
, so
that the prevalence
of
u
s
e
o
f
th
ese
dr
ug
s
w
a
s
1
.
408
%
(
2
3
/
163
4)
(
T
ab
le
2)
. Th
e r
e
su
lts of
th
i
s
stud
y ind
i
cate th
at m
o
st o
f
th
e
alp
r
azo
l
am
u
s
e w
a
s in
t
h
e ag
e gr
oup
6
0
-
7
4
y
ear
s
(
2
1
/
91
, 3%)
,
fo
llo
w
e
d
by ag
e
g
r
ou
p 75-
90
(
2
/
8
.7
%),
w
h
ile
at
the
ve
ry old age group
(> 90
year
s
)
t
h
ere i
s
no
use
of alprazolam
.
Tabl
e 1. Po
p
u
l
a
t
i
on’s
Se
x
a
n
d Age
Di
st
ri
bu
t
i
o
n
Total (n=1634)
Percen
tage (n=100%
)
Age
60-
74 year
75-
90 year
>90 year
Sex
Male
Fe
m
a
l
e
1365
259
10
911
723
83
15.
9
0.
6
55.
8
44.
2
The t
o
t
a
l
of 1
3
pat
i
e
nt
s was
wom
e
n (56
.
5
%
) an
d t
h
e re
m
a
i
n
i
ng 1
3
w
e
re m
e
n (43.
5
%
). B
a
sed
o
n
these
data we can determ
ine
that
the pre
v
alence of use
i
n
wom
e
n
is
1
.
79
8% (13
/
72
3)
an
d m
e
n
ar
e 1.09
%
(1
0/9
0
1
).
T
h
is
sug
g
ests t
h
at
m
o
re
wom
a
n recieve alprazol
a
m
than m
a
n.
For
j
o
b va
ri
abl
e
, al
praz
ol
am
m
o
st
wi
del
y
adm
i
ni
st
ered t
o
wom
e
n w
h
o
w
o
r
k
as
h
ouse
w
i
v
es (
5
2.
1%;
12
),
f
o
l
l
o
we
d
by
pat
i
e
nt
s
w
h
o are
n
o
t
wo
r
k
i
n
g
due
t
o
ol
d a
g
e (
3
9.
1%;
9
)
,
an
d l
a
st
, t
h
e sel
f-em
p
l
o
y
e
d a
n
d
farm
er 4.3%, respectively (1
patient). T
h
e s
o
ci
o
d
em
ogra
p
hi
c dat
a
can
be
seen
i
n
Ta
bl
e
3.
Al
p
r
azol
a
m
was gi
ve
n t
o
h
o
s
pi
t
a
l
i
zed pat
i
ent
s
i
n
i
n
t
e
r
n
a
l
m
e
di
ci
ne wa
rds
f
o
r
va
ri
o
u
s
i
ndi
cat
i
o
ns
according to
ICD 10 criteria. From
thes
e re
sults they appe
ar that the dia
g
nosis i
n
patient
s sprea
d
without any
dom
inant disease.
Al
pra
z
ol
am
was
adm
i
ni
st
ered
i
n
pat
i
e
nt
s
wi
t
h
a
n
i
ndicat
ion of
athe
rosc
erotic heart dis
ease,
d
i
arrho
ea and
g
a
stro
en
teritis o
f
p
r
esu
m
ed
i
n
fectiou
s
orig
i
n
, d
y
sp
ep
sia, u
n
s
p
ecified
g
a
stritis, an
d
th
y
r
o
t
o
x
i
c
heart disease (THD)
/
t
h
yrotoxic
o
sis
/
unss
pecified, two c
a
ses res
p
ective
l
y
(8.
7
%
)
.
Whi
l
e the rest
w
h
i
c
h a
r
e
acute myocardial infarction,
anaem
ia
, asthma, chronic
obstructive pul
m
ona
ry
diseas
e, ch
ro
nic re
na
l failure,
con
g
estive
hea
r
t failu
re (C
H
F
), e
s
eential (
p
rim
a
ry
) hy
pe
rt
ensi
o
n
,
gast
ri
c ul
cer
, hy
pert
ensi
ve
hea
r
t
d
i
sease
wi
t
h
o
u
t
(c
on
gest
i
v
e)
heart
fai
l
u
re, n
o
n
-i
nsul
i
n
dep
e
nde
nt
di
abet
es
m
e
l
l
i
t
u
s, ot
her di
sea
s
es o
f
d
i
g
e
stiv
e system
(
m
e
l
aen
a),
oth
e
r
g
a
stritis, an
d vo
lu
m
e
d
e
pletio
n
is
o
n
l
y a sing
le case
(4.3
%).
Data ind
i
cativ
e
of
al
praz
ol
am
adm
i
ni
st
rat
i
on
can
be see
n
i
n
Tabl
e
4.
Table 5 s
h
ows
that the entire uses
of alprazola
m
were im
prope
r (100%
)
because the
r
e were a lack of
records or a through asses
s
ment in
an
xi
et
y
di
so
rde
r
s a
nd
pani
c at
t
acks i
n
the patie
nt'
s
medical record, while
al
praz
ol
am
onl
y
i
ndi
cat
ed
fo
r
pani
c at
t
acks
a
nd
ge
nerel
i
zed
anxiety dis
o
rder. T
h
ese
data
indicate that there is
Po
ten
tially In
ap
pro
p
riate Prescrip
tion
s
(PIP)
in
g
e
riatric
p
a
tien
t
s.
Al
p
r
azol
a
m
i
s
gi
ve
n
out
si
de
of
t
h
e m
a
i
n
i
n
di
cat
i
ons
gi
ve
n a
b
o
v
e a
n
d t
h
i
s
dr
ug
j
u
st
u
s
e base
d
o
n
anot
her
ef
fect
of
t
h
e nat
u
re o
f
t
h
i
s
d
r
u
g
w
o
r
k
whi
c
h ba
sically d
o
e
s
no
t fit
in
th
e con
t
ex
t
o
f
ration
a
l treat
m
en
t.
Meanwhile, when vie
w
ed
from
the prim
ar
y diagnosis
, the a
p
propriateness
of t
h
e
prevalence ca
n
not
be
assessed
direct
ly, because all patients were
treated over
the
m
a
in indications a
nd
alpra
z
olam m
o
stly just
a
sy
m
p
to
m
a
tic d
r
ug
ag
ain
s
t t
h
e
p
a
tien
t
's co
m
p
l
a
in
t.
Table 2. Pre
v
al
ence Use of
Al
praz
olam
Side
e
ffects of
treatm
e
nt
can not be found
in
the m
e
dical records
be
cause t
h
e side
effects
of
treat
m
e
n
t
are
n
o
t
written b
y
do
ctors an
d nu
rses who
treated
p
a
tien
t
s. Th
is
is
d
u
e
to
t
h
e larg
e
nu
m
b
er of
h
o
s
p
italized
p
a
tien
t
s in
an
d out ev
ery
d
a
y, so
th
at th
e m
e
d
i
cal tea
m
d
i
fficu
lt
to
fo
llow
up
al
l th
e p
a
tien
t
s.
3.
1.
Discussion
From
the Table 2 above
, known that the
pre
v
alence
of
the
use of alpraz
ol
a
m
in geriatric patients are
1.
40
8%
, or
23
of t
h
e 1
6
3
4
p
a
t
i
e
nt
s wh
o w
e
re ho
spi
t
a
l
i
zed. Thi
s
fi
gu
re
sho
w
s t
h
at
t
h
e
use of al
p
r
az
ol
am
i
s
l
o
w.
Ho
we
ver
,
use o
f
t
h
ese
dr
u
g
s sh
o
u
l
d
be al
so re
vi
e
w
ed
not
onl
y
by
i
t
s
num
bers but
al
so
fr
o
m
t
h
e
i
ndi
cat
i
o
n or t
h
e reas
on
why
doct
o
r ch
o
o
se
t
h
i
s
dru
g
. R
e
con
n
e
x
i
o
n (
2
0
1
0
)
m
e
nt
i
ons t
h
at
t
h
e el
derl
y
aged
ove
r
65 yea
r
s
get presc
r
iption
of be
nz
odiazepines a
s
m
u
ch as
11%, m
o
re t
h
an
the a
dult
population whic
h
n Receive
n Not R
eceive
% Rece
ive
% Not
Receive
>
60 year
Male
Fe
m
a
l
e
23
10
13
1611
901
710
1.
408
1.
09
1.
798
98.
592
98.
902
98.
202
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
16:
1
9
3
– 20
0
19
6
only 5% [12]. The study result of Naka
o et al. (2009) [13] also found m
o
re
elderly patients receive
d this drug
class th
an youn
g adu
lts.
Tabl
e 3. Soci
o Dem
ogra
phi
c Dat
a
o
f
Al
p
r
az
ol
am
User
Total (n= 23)
Percen
tage (n=100%
)
Age
60-
74 y
ear
75-
90 y
ear
>90 y
ear
Sex
Male
Fe
m
a
le
Jobs
Not Work
Housewives
Far
m
e
r
E
n
tr
epr
e
neur
21
2
0
10
13
9
12
1
1
91.
3
8.
7
0
43.
5
56.
5
39.
1
52.
1
4.
3
4,
3
Kha
w
a
j
a et
al
(2
00
5)
[1
4]
i
n
Paki
st
a
n
res
earchi
ng
benz
odi
aze
pi
nes
pr
escri
p
t
i
o
n i
n
hos
pi
t
a
l
i
zed
pat
i
e
nt
s, a
n
d
t
h
ey
g
o
t
res
u
l
t
t
h
at
am
ong
t
h
e cl
ass o
f
b
e
nzo
d
i
aze
pi
ne,
al
praz
ol
am
was t
h
e sec
o
n
d
m
o
st
com
m
onl
y
pre
s
cri
b
e
d
i
n
t
h
e
am
ount
o
f
11
.
4
%
(4
4
)
.
O
n
t
h
e p
r
eval
e
n
ce,
o
f
t
h
e
use
of al
p
r
azol
a
m
i
n
t
h
at
st
u
dy
were
2
,
40
4
%
(5
/20
8
). Th
is sug
g
e
sts th
at th
e
p
r
ev
alen
ce
of th
e use of alprazo
l
am
in
RSMH still lo
w com
p
ared
with this st
udy
. Khawa
j
a'
s re
search also
found that th
e d
e
part
m
e
nt
of i
n
t
e
r
n
al
m
e
di
cine i
s
t
h
e
de
par
t
em
ent
whe
r
e
m
o
st
pat
i
ent
s
t
ook
benz
odi
aze
pi
ne (
2
2
.
7% o
f
4
4
pat
i
e
nt
s). T
h
e am
o
unt
o
f
use o
f
al
praz
ol
am
i
n
i
n
terna
l
m
e
di
ci
ne wa
rd
s achi
e
vi
ng
1
0
%
of
t
h
e
2
08
pat
i
e
nt
s. P
r
e
v
a
l
ence o
f
al
p
r
az
ol
am
ad
m
i
ni
st
r
a
t
i
on i
n
t
h
i
s
st
udy
i
s
still
lo
w
wh
en co
m
p
ared
to
research
condu
cted
b
y
V
a
li et al (2
0
12) [15
]
in
Iran
w
h
ich
fo
und
th
at th
e
pre
v
alence
us
e
of alprazolam
i
s
ab
out
3.
3
0
2
%
(
7
/
2
12
).
Based on Tabl
e 3, it can be concl
ude
d that the gr
oup of
60-74 years was t
h
e m
o
st group
who recei
ve
al
praz
ol
am
(91
.
3%
) w
h
i
c
h m
a
y
be associ
ated with an ave
r
a
g
e lif
e expectancy of
people
i
n
So
ut
h S
u
m
a
tra.
I
n
the 75-90 year
age group, the
r
e are 2 us
es
(8.7%), while at the ve
ry old ag
e gr
ou
p (>
90
y
ears) t
h
er
e i
s
no
use
of
al
pr
azol
a
m
.
Thi
s
i
s
c
onsi
s
t
e
nt
wi
t
h
resea
r
ch
co
n
duct
e
d
by
Na
ka
o et
al
. (
2
00
9)
[
1
3]
wh
o
fi
n
d
o
u
t
t
h
at
t
h
e
65-74 year a
g
e
group is the
most
group t
h
at received
be
nz
odiazep
ine (5355
patients).
The cal
cul
a
t
i
o
n i
n
Ta
bl
e 2 s
h
o
w
s t
h
at
t
h
e
pre
v
al
ence
use
of al
praz
ol
am
i
n
m
e
n gro
u
p
am
ount
e
d
t
o
1.
09
% an
d t
h
e
use i
n
t
h
e fem
a
l
e
gr
ou
p i
s
1
.
79
8%
. Thi
s
i
s
con
s
i
s
t
e
nt
wi
t
h
dat
a
fr
om
t
h
e WH
O
doc
um
ent
O
n
Substance
Abuse Program
(1996) [16]
whic
h states that the benz
odiazepi
n
e prescri
p
tions doubled in
fe
male
p
a
tien
t
s th
an
male p
a
tien
t
s.
Si
m
ilar d
a
ta were
p
r
esen
ted
b
y
Reconn
ex
i
o
n
(20
10)
, t
h
e
gr
oup
th
at exp
e
r
i
en
ced
i
n
t
h
e t
r
eatm
e
nt
of pat
i
e
nt
s wh
o get
d
e
pen
d
e
n
ce t
o
benz
odi
aze
pi
ne i
n
Vi
ct
ori
a
, t
h
at
t
h
e class o
f
benz
odiazepi
n
e prescri
b
ed more
in
fem
a
le patients than m
a
le [12].
Tabl
e 4. Al
p
r
a
z
ol
am
Indi
cat
i
ons
Total (n=23)
Percen
tage (100%)
Acute My
ocar
dial
I
n
far
c
tion,
Unspecified
1
4.
3
Anae
m
i
a
.
Unspecif
i
ed 1
4.3
Asth
m
a
Unspecified
1
4.
3
Atherosclerotic H
e
art Dise
ase (Cad)
2
8.7
Chronic Obstructive Pul
m
ona
ry Dise
ase,
Unspecif
i
ed
1 4.
3
Chr
onic Renal Failur
e,
Unspecified
1
4.
3
Congestive Hear
t
Failur
e
(
C
hf)
1
4.
3
Diarrhoea & Gastroenteritis
Of Presu
m
e
d
Infectious
Origin
2 8.
7
Dy
spepsia 2
8.
7
E
s
eential (Pr
i
m
a
ry)
Hy
per
t
ension
1
4.
3
Gastr
i
c Ulcer
1
4.
3
Gastritis, Unspecified
2
8.7
Hy
per
t
ensive Heart Disease
W
ithout
(
C
ongestive)
Heart Failure
1 4.
3
Non I
n
sulin Dependent Diabetes M
e
llitus
1
4.
3
Other Diseas
es Of
Digestive Syste
m
=> Mel
aena
1
4.3
Other Gast
ritis
1
4.3
T
h
y
r
otoxic Hear
t
Disease(Thd)/
T
hyr
o
toxicosis/Uns
s
pe
cif
i
ed
2 8.
7
Volu
m
e
Depletion
1
4,
3
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
The
Preval
e
nc
e of
Al
pra
z
ol
a
m
Uses i
n
Geri
at
ri
c Pat
i
e
nt
s
at
Dr
. M
o
ha
m
m
a
d
H
o
esi
n
..
..
(
Y
oh
a
n
es
Feb
r
i
ant
o)
19
7
Naka
o
et
al
[
1
3]
al
so
f
o
u
n
d
t
h
at
fem
a
l
e
pat
i
e
nt
s re
cei
ve m
o
re
be
nz
odi
aze
pi
ne
p
r
escri
p
t
i
ons
t
h
a
n
m
e
n
i
n
h
o
s
p
i
t
a
l
i
zed pat
i
e
nt
s i
n
var
i
ous
de
part
m
e
nt
s (
2
1
.
6
%
:
1
8
.
6%
) an
d t
h
e
p
e
rcent
a
ge wa
s
i
n
creasi
n
g acc
or
di
n
g
to
th
e ag
e. This is si
milar to
th
e resu
lts of Rao
o
f
et al.
[
17]
resea
r
c
h
i
n
Paki
st
a
n
w
h
i
c
h fo
u
nd t
h
at
m
o
re
fem
a
le patients get
benz
odiazepine t
h
an the
male patient
s (37.8%: 25.3%
)
and
users
are
m
o
re likely in olde
r
age. M
o
re
n
u
m
ber of
pre
s
cr
i
b
i
n
g
i
n
fem
a
le pat
i
e
nt
s m
a
y
b
e
du
e to
t
h
e
lo
ng
er life e
xpectancy of fem
a
le than
m
a
l
e
[18]
.
In
job va
riable
, these res
u
lts are also
co
nsi
s
t
e
nt
wi
t
h
st
udi
es of R
a
o
o
f
et al
[1
7]
wh
o f
o
un
d t
h
at
t
h
e
ho
use
w
i
f
e i
s
t
h
e m
o
st
work
gro
u
p
s w
h
i
c
h
get
t
i
ng al
praz
ol
am in
th
eir l
i
fe in
Pak
i
stan. That researc
h
was
lin
k
i
ng
m
a
rital
statu
s
as t
h
e
psych
o
s
o
c
ial correlatio
n with
mental disorde
r
s.
Khawa
j
a et
al [
1
4
]
also
f
oun
d th
e
sam
e
thing that
hous
ewife
is t
h
e m
o
st grou
p
of inpatients who recei
ved be
nzodiazepi
n
es.
C
ope
rni
c
us
Kn
owl
e
dge
Sy
st
e
m
at
UK i
n
Is
bi
st
er [
1
9]
pr
o
v
i
d
e
dat
a
of al
praz
ol
am
ad
m
i
ni
st
rat
i
o
n
i
n
gene
ral
pat
i
e
nt
s d
u
ri
ng
J
une
1
st
,
20
02
t
o
Sep
t
em
b
e
r
30
th
2
002
p
e
ri
o
d
by a g
e
n
e
ral
practitio
n
e
r.
Th
e d
a
ta
obt
ai
ne
d s
h
ow
s t
h
at
t
h
e i
ndi
c
a
t
i
on
of al
praz
ol
am
prescri
p
t
i
on
as f
o
l
l
o
ws:
31
0 case
s
of
p
a
ni
c di
s
o
r
d
e
r
(
4
8
%
)
,
19
4
cases o
f
a
nxi
et
y
(
30%
), dep
r
essi
on 1
8
cases
(
2
.
6
%)
, a
nxiety / depres
sion
26 cases (4%), ins
o
m
n
ia 9 cases
(
1
.6
%)
,
o
t
h
e
r
8
0
cases (12%)
,
an
d
no
in
d
i
cation
194 cases. Th
ese d
a
ta sugg
est th
at ad
m
i
n
i
st
r
a
tio
n
o
f
alpraz
olam
outside of t
h
e m
a
in / im
precise indication ca
n
reach
107 case
s
(9 cases
of ins
o
m
n
ia, depress
i
on
18
cases, a
n
d ot
he
r
80 cases).
Tabl
e
5. T
h
e
P
r
o
p
o
rt
i
o
n
of
Pr
eci
se or
Im
pre
c
i
s
e In
di
cat
i
o
n
Total (n=23)
Percen
tage (100%)
Precise
Im
p
r
ec
i
s
e
0
23
0
100
Naka
o
et al
[13] in Japan conducted a study of hosp
italized patients who r
eceived benz
odiazepines
in the
hos
p
ital. The
res
u
lt ob
t
a
ined t
h
at the
m
o
st patient who took
benz
odiazepine are
patients with i
n
dication
of
ch
ro
ni
c
re
n
a
l
fai
l
u
re
(
3
1.
3%)
,
fol
l
o
we
d
by
heart
fai
l
u
re (
2
9.
3%
), ac
ut
e m
y
ocardi
al
i
n
fa
rct
i
o
n
(2
8
.
9%
),
m
a
l
i
gnant
ne
o
p
l
a
sm
of t
h
e l
i
v
er a
nd i
n
t
r
a
h
e
p
at
i
c
bi
l
e
duct
s
(2
8.
0%)
,
p
o
st
-
p
r
o
ce
du
ral
di
s
o
r
d
er
s o
f
t
h
e
n
e
rv
o
u
s
sy
st
em
(28
.
0
%
), m
a
l
i
gnant
ne
opl
asm
of
t
h
e
br
o
n
ch
us
an
d l
u
n
g
(
2
7
.
7%
),
n
oni
ns
ul
i
n
-
d
epe
n
dent
di
abet
e
s
m
e
l
l
i
t
u
s (2
5
.
0
%
), a
n
d m
a
l
i
gnant
ne
o
p
l
a
sm
of t
h
e
bl
a
dde
r
(2
2.
2%)
.
Meanwhile, Khawa
j
a
et al
[1
4]
fo
un
d i
n
hi
s researc
h
t
h
at
anxi
et
y
,
i
n
som
n
i
a
, agi
t
a
t
i
on, an
d
dep
r
essi
on a
r
e
t
h
e reaso
n
t
h
at
doct
o
rs us
e
for
pre
s
cri
b
i
n
g al
praz
ol
am
in h
o
s
p
i
t
a
l
i
zed pat
i
e
nt
s at
Paki
st
an
Teaching Hos
p
ital.
Di
vac
et
al
[2
0]
al
s
o
fo
u
n
d
t
h
at
t
h
e
cl
ass
of
be
nz
odi
aze
pi
nes
o
f
t
e
n a
d
m
i
ni
st
er
ed t
o
p
a
tien
t
s with
card
i
o
v
a
scu
l
ar p
r
ob
lem
s
an
d
n
on-p
s
ych
i
at
ric d
i
seases wi
th
ou
t th
e
p
o
ssib
ility o
f
an
an
x
i
ety
di
so
rde
r
or
ot
h
e
r i
n
di
cat
i
o
n
s
of
be
nz
odi
aze
p
i
ne adm
i
ni
st
rat
i
on.
The tende
n
cy of t
h
e alprazol
a
m
wr
ong
prescrip
tion
or in
cl
u
d
e
d
in
t
h
e cat
egory of PIP a
l
so occ
u
r i
n
researc
h
c
o
nd
u
c
t
e
d by
To
bat
[2
1]
w
h
o f
o
un
d ei
g
h
t
geri
at
ri
c pat
i
e
nt
s
w
h
o
wer
e
t
r
eat
ed
a
t
t
h
e de
pa
rt
m
e
nt
o
f
i
n
t
e
rnal
m
e
di
ci
ne
war
d
s at
D
R
. M
.
Djam
i
l
Hos
p
i
t
a
l
Pa
dan
g
got
al
praz
ol
a
m
out
si
de o
f
i
t
s t
r
ul
y
i
n
di
cat
i
ons
.
In
that study the
side effects of treat
m
e
nt
occur
r
ed i
n
t
w
o p
a
t
i
e
nt
s wh
o
undergo treatm
e
nt with alpraz
olam
.
To
bat
researc
h
usi
n
g a pr
os
pe
ct
i
v
e
m
e
t
hod f
o
r
3 m
ont
hs so
t
h
at
t
h
e si
de effect
can
be o
b
s
erve
d, i
n
co
nt
rast
t
o
t
h
ese st
u
d
i
e
s t
h
at
use
desc
ri
pt
i
v
e m
e
t
hod t
h
r
o
ug
h a
n
al
y
s
i
s
of
m
e
di
cal
recor
d
s s
o
t
h
at
t
h
e si
de e
ffe
c
t
s of
t
r
eatm
e
nt
can not
be f
o
u
n
d
.
The use of alprazolam as a form of
in
app
r
opriate treat
m
e
n
t
is also
fo
und
in
th
e stu
d
y
of Ak
azawa
et
al
.
[2
2
]
in
Japan
.
Th
at stu
d
y
p
r
o
v
i
d
e
d
d
a
ta o
f
10
class dru
g
s
wh
ich
m
o
st o
f
ten
in
cl
u
d
ed
in
th
e Po
ten
ttial
y
Ina
p
pr
op
ri
at
e
m
e
di
cat
i
on i
n
el
derl
y
pat
i
e
nt
s an
d t
h
e
b
e
nzo
d
i
aze
pi
ne
i
s
t
h
e cl
ass
num
ber t
w
o
o
f
d
r
ugs
co
mm
o
n
l
y p
r
escr
ib
ed
in
ap
pro
p
r
i
ately (
1
1.4% (
756
/66
28)
), w
ith
a sho
r
t-actin
g
class as
m
u
ch
as 3
.
3
%
o
r
222
p
a
tien
t
s. Th
is
su
gg
ests t
h
at t
h
ere is
a trend
in th
e
wrong
p
r
escrip
tion al
praz
olam
in ge
riatric pati
ents in
vari
ous
co
u
n
t
r
i
e
s.
Howe
ver, furt
her
resea
r
ch by Akaza
wa et
al. (2012)
[23] in Ja
pan through t
h
e reci
pe
analysis als
o
found t
h
at there is a trend
of
alpraz
ol
am
impr
o
p
er
pre
s
cri
b
i
ng i
n
ge
ri
at
ri
c
pat
i
e
nt
s acc
or
di
n
g
t
o
t
h
e cri
t
eri
a
o
f
beers
in
2012. Ak
azawa
et
al found the
r
e
we
re
24 (7.3%)
pa
tients ta
king alpraz
olam
outside the
m
a
in
i
ndi
cat
i
o
n. Na
kao et
al
[1
3]
al
so st
ated that the benz
odiaz
epine class of
dr
u
g
s i
s
very
oft
e
n adm
i
ni
stered i
n
the hos
pital without doc
u
m
e
nta
tion of the
indications
. Elliot
et al
[2
4
]
also
fou
nd th
at in
ap
propriately
benz
odiazepi
n
e prescri
b
ing reach
16% of 36% pre
s
cription.
Side effects of alpraz
olam
in the treatm
e
nt of
ho
sp
itali
zed
p
a
tien
t
s i
n
th
is stud
y co
u
l
d
no
t be
co
nf
ir
m
e
d
th
rou
gh m
e
d
i
cal r
ecord
beca
use
the side
effect
s we
re
not
wri
tten
b
y
a m
e
d
i
cal tea
m
in
the care
pr
ocess
.
H
o
we
ver
,
som
e
com
m
on si
de ef
fect
s i
n
pat
i
e
nts treated with alpra
z
ol
am
are seizures, l
o
ss
of
co
ord
i
n
a
tion
(atax
i
a), and
d
i
fficu
lty o
n
con
c
en
trating
,
m
e
mo
ry im
p
a
irm
e
n
t/tran
sien
t am
n
e
sia, h
a
llu
ci
n
a
t
i
o
n
s
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
16:
1
9
3
– 20
0
19
8
d
e
p
e
rso
n
a
lizatio
n, taste d
i
so
rd
ers, d
y
st
on
ia, irritab
ility, an
orex
ia,
fatig
u
e
, sed
a
ti
o
n
, m
u
scu
l
o
s
k
e
letal
weakness
, a
n
d
incontinence.
Beer'
s
criteria in 2012
a
d
voc
a
ted
a focus
on
t
h
e use of benzodiaze
pi
nes
,
in this ca
se t
h
e class
of
sho
r
t
-
act
i
n
g
b
e
nzo
d
i
aze
pne;
al
praz
ol
am
. B
eer rec
o
m
m
end
t
o
a
v
oi
d t
h
e
use
of
be
n
z
odi
aze
pi
nes
t
o
t
r
eat
patients
with insom
n
ia, a
g
itation, a
nd delirium
b
ecause the elderly have inc
r
eased sensitivity to
benz
odiazepi
n
es and i
n
crease
the
risk
of c
o
gnitive im
pair
ment,
delirium
,
falls, fract
ures,
and accide
nts
[25].
Al
p
r
azol
a
m
on
l
y
i
ndi
cat
ed f
o
r pat
i
e
nt
s wi
t
h
ge
neral
i
zed
a
nxi
et
y
di
so
rde
r
s/
G
A
D
an
d p
a
ni
c
at
t
acks
w
ith
o
r
w
ithou
t ag
or
apob
ia. Ho
w
e
v
e
r
,
i
n
f
act, alpr
azo
l
am
o
f
ten
prescrib
ed to
p
a
tien
t
s with co
m
p
lain
ts of
d
i
fficu
lty sleep
ing
(in
s
o
m
n
i
a), esp
ecially b
y
g
e
n
e
ra
l p
r
actitio
n
e
rs [1
6
]
. Ho
wev
e
r,
in
g
e
riatric p
a
tien
t
s
theirselves
,
s
p
ecifically for
GAD a
n
d pa
ni
c attacks, alprazolam
shoul
d be
a
voi
de
d because treatm
e
nt with
th
is d
r
ug
will cau
s
e sid
e
effects su
ch
as falls, i
m
p
a
ired
m
e
mo
ry an
d
accu
m
u
l
atio
n
eff
ects o
n
t
h
e b
o
d
y
.
It is
as
fo
rm
ul
at
ed by
t
h
e
W
e
st
er
n A
u
st
ral
i
a
n Psy
c
h
o
t
r
opi
c D
r
u
g
s
Committee [26] and The Co
ll
ege of Psychia
t
ry of
I
r
e
land
(20
12)
[
2
7
]
th
at suggest to
u
s
e selectiv
e ser
o
t
o
n
i
n r
e
up
tak
e
inh
i
bito
r
s
(
S
SRI
s
)
in
th
e case of
an
x
i
ety
di
so
rde
r
s i
n
t
h
e ge
ri
at
ri
c p
a
t
i
e
nt
gro
u
p
s
rat
h
er t
h
a
n
al
praz
ol
am
and av
oi
d t
h
e
use o
f
al
l
t
ypes o
f
benz
odiazepi
n
e.
Tabl
e
6. R
e
s
p
o
nde
nt
s’
s C
h
a
r
a
c
t
e
ri
st
i
c
s
Variable
Total (n=23)
Percen
tage (100%)
Sex
Male
Fe
m
a
le
10
13
43.
47
56.
53
Age
65-
74 y
ear
75-
90 y
ear
>90 y
ear
21
2
0
91.
31
8.
69
0
Dosage
0,
5 M
g
1 M
g
13
10
56.
53
43.
47
Frequen
c
y
1 X 1 day
(
n
ight)
23
100
Durat
i
on of
drug
use
1 day
2 day
s
3 day
s
4 day
s
5 day
s
5 day
s
(
b
r
ought hom
e)
6 day
s
9 day
s
13 day
s
15 day
s
15 day
s
(
b
r
ought ho
m
e
)
2
4
3
1
4
3
2
1
1
1
1
8.
69
17.
39
13.
04
4.
34
17.
39
13.
04
8.
69
4.
34
4.
34
4.
34
4.
34
Pa
tient
’
s co
mpla
i
n
t/ sy
mpto
m
Cough
Ner
vous
Chest pain
Epigastric pain
Joint pain
Hear
tbur
n
Headache
Shor
tness of br
eath
No indication
Can’t sleep
Not known
1
1
2
1
1
1
1
2
2
9
2
4.
3
4.
3
8.
7
4.
3
4.
3
4.
3
4.
3
8.
7
8.
7
39.
1
8.
7
B
a
sed
on
t
h
i
s
rec
o
m
m
e
ndat
i
on,
t
h
e a
c
t
u
al
adm
i
ni
st
rat
i
on
of
al
praz
ol
a
m
i
n
ge
ri
at
ri
c pat
i
e
nt
s i
n
i
n
t
e
rnal
m
e
di
cine wa
rd
s R
S
M
H
i
s
im
pro
p
er
whe
n
vi
ewe
d
fro
m
two
sid
e
s, fro
m
th
e in
som
n
ia
th
at is cl
early
wr
on
g a
n
d f
r
o
m
securi
t
y
asp
ect
of t
h
e m
a
in i
n
di
cat
i
ons
(
G
A
D
a
n
d
pa
ni
c at
t
acks).
N
o
net
h
el
ess,
som
e
ot
he
r
g
u
i
d
e
lin
e still allo
ws th
e u
s
e
o
f
al
p
r
azo
l
am
i
n
g
e
riatric
p
a
tien
t
s,
b
u
t
with
so
m
e
sp
ecial att
e
n
tio
n, su
ch as do
se,
du
rat
i
o
n of use
,
an
d
i
n
t
e
ract
i
o
n.
There
are
se
ve
ral reas
ons
why the
im
p
r
op
er ad
m
i
n
i
str
a
tio
n of
alpr
az
olam m
a
y occur i
n
the
geriatric
p
a
tien
t
, su
ch
as th
e co
nd
itio
n o
f
th
e
p
a
tien
t
s th
em
selv
es
an
d th
e
factors
th
at are
d
e
ri
v
e
d
fro
m
th
e p
hysician
(knowle
dge
on the
panel c
r
iteria, a
dhe
rence
to the
gu
idline
,
and
de
pende
n
ts fo
r a
pha
rmaceutical com
p
any)
[2
8]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
The
Preval
e
nc
e of
Al
pra
z
ol
a
m
Uses i
n
Geri
at
ri
c Pat
i
e
nt
s
at
Dr
. M
o
ha
m
m
a
d
H
o
esi
n
..
..
(
Y
oh
a
n
es
Feb
r
i
ant
o)
19
9
Meanwhile, ac
cording t
o
M
oylan et
al (2012) there
are
se
veral
reas
o
n
s fo
r th
e
wr
ong
pr
escr
i
p
tio
n of
alpraz
olam
tha
t
are due t
o
physician pre
f
ere
n
ce c
ont
rary
to treatm
e
n
t
g
u
i
d
e
lin
es, su
ch
as sk
ep
ticism
,
l
ack
of
aware
n
ess a
n
d
un
derst
a
ndi
ng
of t
h
e p
r
i
n
ci
pl
es of g
u
i
d
a
n
ce
, l
ack of e
xpec
t
at
i
ons of t
r
eat
m
e
nt
out
com
e
s, an
d
t
h
e e
x
i
s
t
e
nce
o
f
a
pat
t
e
r
n
of
p
r
act
i
ce ha
bi
t
s
(
una
bl
e
or
un
m
o
tiv
ated to
ch
an
g
e
practice
p
a
ttern
s), as well
as th
e
patient'
s
own
prefe
r
ences
(i
n t
h
is case t
h
e
de
pende
n
ce).
Th
e clin
ician
s
d
e
sire to qu
i
c
k
l
y reliev
e
the p
a
tien
t
's co
m
p
la
in
ts (su
c
h as in
so
m
n
ia)
an
d
ex
isting
beha
vi
o
r
al
pat
t
erns
[6]
,
m
a
ke al
praz
ol
am
becom
e
t
h
e fi
rst
choi
ce f
o
r ad
dre
ssi
ng
pat
i
e
nt
c
o
m
p
l
a
i
n
t
s
t
h
at
cause
the pre
v
alence
use
of alprazol
a
m
in ge
riatri
c
pat
i
e
nt
s at
R
S
M
H
Pal
e
m
b
an
g
was
1.
40
8%
.
Th
e li
m
itat
i
o
n
o
f
th
is stud
y
is th
at th
e research
e
r
s are
not
able to directl
y
assess the re
asons why
doct
o
rs
gi
ve a
l
praz
ol
am
t
o
pat
i
e
nt
s, s
o
t
h
at
researche
r
s
coul
d o
n
l
y
fo
r
m
ul
at
e i
t
i
n
t
h
e form
of t
h
e
m
a
in
i
ndi
cat
i
o
ns an
d pat
i
e
nt
com
p
l
a
i
n
t
s
du
ri
n
g
t
h
e t
r
eat
m
e
nt
proces
s as p
r
ese
n
t
e
d i
n
t
h
e t
a
b
l
e and t
h
e de
sc
ri
pt
i
o
n
above.
R
e
gar
d
l
e
ss, t
h
e
pre
v
al
ence
us
e of al
praz
ol
a
m
i
n
geri
at
ri
c
pat
i
e
nt
s i
n
i
n
t
e
rnal
m
e
di
ci
ne war
d
s R
S
M
H
is still low com
p
ared to sim
i
lar studi
es that
have been
done. T
h
is is pos
sibly because t
h
e use
of alpra
z
ola
m
was m
o
re in
o
u
t
p
a
tien
t
s th
an in
p
a
tien
t
s settin
g
.
In
add
ition
,
th
e stud
y sho
w
s th
at clob
aza
m
is
m
o
re
wid
e
ly
use
d
t
h
a
n
al
pra
z
ol
am
i
n
deal
i
n
g
wi
t
h
p
r
obl
e
m
s of pat
i
e
nt
s
du
ri
n
g
t
h
e t
r
eat
m
e
nt
pr
ocess
.
Howev
e
r,
th
e p
e
rsisten
ces o
f
th
e u
s
e of
alprazo
la
m
are inclin
ed
t
o
wards Po
ten
ttialy Inap
pro
p
riate
Medication (PIM) according to criteria of
B
eer's shows tha
t
there were s
till a problem
in
the pattern of drug
adm
i
ni
st
rat
i
on i
n
geri
at
ri
c p
a
t
i
e
nt
s and t
h
ese t
h
i
ngs
ca
n
be very
da
n
g
er
o
u
s b
eca
us
e it can lead
to the
em
ergence
o
f
t
h
e
pr
o
b
l
e
m
such as
de
pe
nde
nc
e, t
o
l
e
ra
nce,
and the
effects
of drug
withd
r
awal in
th
e
fu
ture.
4.
CO
NCL
USI
O
N
We can c
o
nclude that the
pre
v
alence
use
of
alpraz
ol
am
i
s
1,
40
8%
wi
t
h
t
h
e 6
0
-
7
4 y
ear
age g
r
ou
p i
s
the large
s
t group
who
received alpr
azolam (21
patients: 91.3%). M
o
re
fem
a
le patient
s getting al
pra
z
olam
th
an
m
a
le
p
a
ti
en
ts with
a p
r
ev
alen
ce ratio
of 1
.
7
9
8
%
: 1
.
09%. In
job
v
a
ri
ab
le, m
o
st p
a
ti
en
ts are h
o
u
s
ewiv
es
(5
2.
1%
). M
o
st
of al
praz
ol
am
gi
ve t
o
pat
i
e
n
t
s wi
t
h
com
p
l
a
i
n
t
s
of at
her
o
s
cerot
i
c
hea
r
t
d
i
sease, di
ar
rh
o
ea an
d
g
a
stro
en
teritis o
f
p
r
esu
m
ed
i
n
fectiou
s
orig
i
n
, d
y
sp
ep
sia, u
n
s
p
ecified
g
a
stritis, an
d
th
y
r
o
t
o
x
i
c h
e
art disease
(TH
D
)/
t
h
y
r
ot
o
x
i
c
osi
s
/
u
nss
p
e
c
i
f
i
e
d. It
can
b
e
concl
u
de
d t
h
at
al
l of al
praz
ol
am
prescri
p
t
i
on
was gi
ven
out
si
de
a
m
e
dical indication (no exact
indication)
.
Wh
ile th
e sid
e
effects of th
e treat
m
en
t co
u
l
d
no
t b
e
repo
rted
in
th
i
s
st
udy
d
u
e t
o
si
de e
ffect
s
of
t
r
eatm
e
nt
does
not include t
h
e
medical record.
ACKNOWLE
DGE
M
ENTS
Th
e au
tho
r
wou
l
d
lik
e t
o
th
ank
th
e
Facu
lty of Med
i
cine
, Sriwijaya
Uni
v
ers
ity
,
m
e
dical record team
,
an
d all th
ose
wh
o h
e
l
p
ed in
t
h
e i
m
p
l
e
m
en
tati
o
n
of t
h
is research.
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