S376 Pe, Other topics • Pattern of benzodiazepines utilization in bhe population of elderly treated in their homes L. lovanovicl M. Prostran 2 *. iInstime of Gerontology, Home Treatment and Care Belgrade, Department for Research a~d Methodology, l lO00 Belgrade, Yugoslaoia; 2Department of Clinical Pharmacology, Pharmacology and Toxicology, School of Medicine, University of Belgrade, Department of Clinical Pharmacology, _Pharmacology and Toxicology, Jl O00 Belgrade, Yugoslaoia Benzodiazepines are the most important sedative-hypnotic drugs, widely used both for middle aged and elderly [1]. Prescribing of benzodiazepines for the elderly population needs strong di- agnostic criteria, selection of the low liposolubile drug with a short t½ and without active metabolites (lorazepam, oxazepam, alptazolam) applied in the lowest therapeutically effective doses with short duration of the therapeutic course, taking into account their pharmakokinetics and pharmacodynamics as well as the pathological changes in the elderly people. Prolonged use of benzodiazepinea without medical control can be a great risk factor in elderly development of serious side effects e.g. prolonged sedation, hypotenalon, falls and hip fractures, delirium, daylight sleeping, even serious cardiorespiratory events in severely ill patients taking many other drugs: drug-drug interaction. The aim of this study was to describe the pattern of benzodiazepine uti- lization: indication and preparations usually prescribed to patients, aged 60 years and over, treated in their homes from 01. ]-an, 2001 to 31. Dec, 2002. The data were collected in direct interwiev with patients and from theirs medical histories. All data were computed on a PC (EPIe) and presented in absolute and relative numbers. The study was conducted on a statistically significant sample of 16.7% newly admitted patients on home treatment during 2001 (N=108/645;81f/27m). Interviewed patients (median age 77.694-8.76, a range of 60-95 years) were functionally disabled with mental declining, caracterized with polimorbidit5, and a high rate of mortality. 43.52% newly admitted patients have been treated with benzodiazepines regular,/ or a8 needed and more than half, 51,06% used diazepam, One year later, 42,59% patients were used benzodiazepines: 41,30% diazepam, 28,26% bromazepam, 10,87% alprazolam, 13,04% lorazepam, a few midazolam, prazepam and temazepam, Psychiatrics diagnosed a few cases of dementia (F01-03), depression (F32), psychoeganic syndrome (organic brain syndrome F07), active psychosis (F22). However, the m~orit 5, of prescriptions were given by general practioners because of patients' complaints related to insomnia, nervousness, distress and feeling of being miserable. Over one half of patients received drugs for cardiovascular diseases (53.27%), 7.18% drugs for psychiatric diseses at the same time with benzo- diazepines. Conelmion-" In an effort to escape the risk factors due to uncontrolled and prolonged consumption of benzodiazepines, it is important to point out the need for continous education of doctors and patients. Also, the tapered discontinuation of benzodiazepines is a must. It should be stressed that the use of these drugs must be rational (the right indication, the short duration). The use of many nonpharmaoological approaches like as psychotherapy, behavioral, relax, light therapy for insomnia and others should be encouraged. References [1] Prostran M, Jovanovio LB, Zildc Lj, Vudcovie S. Tramadol in the treatm~mt of persistent pain in the elderly. European N~ropsyohophar- maoology. 2003;13(Sappl 4):447. • A pharmacokinetic interaclJon study of lamotrigine and olanzapine G.E. Evoniuk, J. Ascher, J. Sidhu, S. Job, J. Theis. GlaxoSmithKline, Neurosciences, I@seareh Triangle Park, ~S,A, hltroduetien-" C o-therapy with antipsychotics and antiepileptics is becoming increasingly common in bipolar disorder. Objective: To examine the pharmacokinetic interactions of olanzapine (OLZ) added to lamotrigine (LTQ) in healthy volunteers. Methods: 52 non-smoking males (age 18-55 years) were randomised to LTG (titrated to 200 ms/day) or placebo (PBO). OLZ (titrated to 15 ms) or PBO were added on days 43-56 resulting in three parallel cohorts receiving the combination of LTG+OLZ (n=16), LTG+PEO (n=12) or OLZ+PEO (n=18) for 2 weeks. Serumblood levels, adverse events (AEs), and blood chemistry were examined. Pharmacokinetic profiles were obtained at steady state. Results: LTG AUC(0-24) and Cmax were, on average, 24% and 20% lower with LTG+OLZ cor@ared with LTQ+PBO, re- spectively. OLZ AUC(0-24) and Cmax were comparable with OLZ+LTG and OLZ monotherapy. AEs were similar with LTQ+OLZ and OLZ+PBO; fewer AEs were reported with LTG+P1;O. The most common AEs were transaminase elevations, fatigue, and dizziness. Transaminase elevations and dizziness were reported at similar frequencies with LT@+OLZ and OLZ+PBO, but not with LTG+PBO. Cenelmiens: The combination of OLZ and LT@ was weE- tolerated, with the type, frequency, and severity of adverse events similar to olanzapine monotherapy. These results support co- administration in patients who may benefit from combination therapy. • Patient functional status/quality of life, safety, and tolerability with long-term modafinil in chronic shift work sleep disorder T. Roth j, C.A. Czeisler 2, M.K. Erman 3, IK. Walsh 4, J.R.L. Schwartz 5, R. Rosenberg 6, B.C. Corset z, D.E Dinges 8, 1Henry Ford Hospital, Sleep Disorders and Researc:~ Center. Detroit, MI, U.S.A.; 2Br@ham and Women ~ Hospital, Dioision of Seep Medicine, Boston, MA, US.A.; SPac/fic Seep Medicine geroices, 7no., n/a, San Diego, CA, USA.; 4 &. 3ohn~ Mercy~St. Luke ~ Hospitals, Sleep Medicine and 2exear& Center. 5~. Louis, M©, USA. ; sfntegris Southwest and Baptist Medical Centers, Zntegris Seep Disorders Center of Oklahoma, Oklahoma City, OK, US.A: 6Northside Hospital, Seep Medicine Institute, Atlanta, GA, US, A,; ZCommunity t~esearch, n/a, Cincinnati, OH, ~S,A,; ~Unioersi%/ of Pennsyloania, Dioision of Sleep and Chronobiolog~, Department of Psychiatry, Philadelphia, PA, rig, A, Objeetiw~." Shift work sleep disorder (SWSD) is characterized by excessive sleepiness during nighttime work hours and/or insomnia during daytime sleep periods [1]. In two 12-week, double-blind, placebo-controlled studies, the wake-promoting agent modafinil significantly improved wakefulness in patients diagnosed with chronic SWSD and was well tolerated [2,3]. The objective of two open-label extension studies was to determine the effects of modafinil on functional status/quality of life (QOL) and continued safety and tolerability in patients diagnosed with chronic SWSD.