Psychotropics and weak opioid analgesics in plasma samples of older hip fracture patients - detection frequencies and consistency with drug records

Br J Clin Pharmacol. 2017 Jul;83(7):1397-1404. doi: 10.1111/bcp.13244. Epub 2017 Mar 9.


Aims: To determine use of psychotropic drugs and weak opioids in hip fracture patients by analysing plasma samples at admission, and compare detected drug frequencies with prescription registry data and drug records.

Methods: Plasma from 250 hip fracture patients aged ≥65 years sampled at hospital admission were analysed by ultra-performance liquid chromatography-tandem mass spectrometry methods for detection of psychotropic drugs and weak opioid analgesics (alcohol also determined). Odds ratios for drugs detected in plasma of hip fracture patients vs. prescription frequencies of the same drugs in an age-, time- and region-matched reference population were calculated. Moreover, recorded and measured drugs were compared.

Results: Psychotropic drugs and/or weak opioid analgesics were detected in 158 (63%) of the patients (median age 84 years; 76% females), while alcohol was found in 19 patients (7.6%). The occurrence of diazepam (odds ratio 1.6; 95% confidence interval 1.1-2.4), nitrazepam (2.3; 1.3-4.1), selective serotonin reuptake inhibitors (1.9; 1.3-2.9) and mirtazapine (2.3; 1.2-4.3) was significantly higher in plasma samples of hip fracture patients than in prescription data from the reference population. Poor consistency between recorded and measured drugs was disclosed for z-hypnotics and benzodiazepines; e.g. diazepam was detected in 29 (11.6%), but only recorded in six (2.4%) of the patients.

Conclusions: Plasma analysis shows that use of antidepressants and benzodiazepines in hip fracture patients is significantly more frequent than respective prescription frequencies in the general elderly population. Moreover, consistency between recorded and actual use of psychotropic fall-risk drugs is poor at hospital admission of hip fracture patients.

Keywords: alcohol; fall risk; hip fracture; psychotropic drugs; weak opioid analgesics.

Publication types

  • Clinical Trial
  • Comparative Study
  • Observational Study

MeSH terms

  • Accidental Falls*
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / blood*
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / blood*
  • Benzodiazepines / adverse effects
  • Benzodiazepines / blood
  • Chromatography, High Pressure Liquid
  • Drug Prescriptions / statistics & numerical data
  • Ethanol / adverse effects
  • Ethanol / blood*
  • Female
  • Hip Fractures / blood*
  • Hip Fractures / etiology
  • Humans
  • Male
  • Norway
  • Odds Ratio
  • Registries / statistics & numerical data
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Selective Serotonin Reuptake Inhibitors / blood
  • Tandem Mass Spectrometry


  • Analgesics, Opioid
  • Antidepressive Agents
  • Serotonin Uptake Inhibitors
  • Benzodiazepines
  • Ethanol