Strand 2 - a) Trazodone b) Homely remedies

13:45 - 14:05 Evaluation of the dose-dependent mechanism of action of Trazodone through Pharmacokinetic-Pharmacodynamic (PK-PD) modelling simulations
Dr Luca Settimo (Clinical Trials and Research, South Tees Hospitals NHS Foundation Trust)

Trazodone is an antidepressant drug particularly used where sedation is required. According to the summary of product characteristics (SPC) it is only licensed to treat depression. However, in clinical practice, psychiatrists and GPs prescribe it also as a hypnotic (given its sedative effects). Very recently Trazodone has been also shown to prevent neurodegeneration (in mice). For this reason, clinical trials are expected to start in humans to assess trazodone’s protective effect in dementia and Alzheimer’s disease (AD). We conducted PK-PD simulations using the software Berkeley Madonna (BM) with different dose regimens of Trazodone in order to recommend the dose to administer to (i) treat insomnia (since this is not specified in the SPC) and (ii) to carry out a clinical trial where Trazodone is tested for the prevention of neurodegeneration in dementia and AD in humans. Our results show that low doses of Trazodone (typically 50 mg od) are ideal in treating insomnia and should be sufficient to display neuroprotective effect in dementia and AD in clinical trials. The results of this study have been recently published: Settimo L.  and Taylor D. J Psychopharmacol. 2018, 32:96-104.

14:05 - 14:25 Barriers and facilitators to the uptake and use of homely medicines policies in care homes in Sunderland
Nuha Katab, University of Sunderland

Background

A homely medicine is a non-prescription medicine which is used for the treatment of self-limiting conditions within a care home setting. Examples include paracetamol, senna and simple linctus. Guidance for their use has been published in NICE Social Care Guideline 1 (2014) but their uptake and use is variable. It has been suggested that use of homely medicines policies have potential to reduce medication waste in care homes.

Aims and Objectives

To explore the views and experiences of care home staff around the use of homely medicines policies within Sunderland.

Methods

Face to face semi-structured interviews were conducted. Participants were purposively sampled from care homes based on their use of a homely medicine policy and type (nursing or residential). Recruitment was via a pharmacy technician providing medicines management support. A topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and thematically analysed. Informed consent was obtained prior to participation and ethical approval was received prior to data collection.

Results and Discussion

6 participants from 6 care homes in Sunderland were included in the sample. In addition to the sampling criteria, care homes also varied in number of residents served (19-113). Participants included one qualified nurse, 4 deputy care home managers and 1 trainee junior care home manager.

Five parent themes were identified from the analysis; potential barriers to homely medicine policy use, potential facilitators, alternative ways to reduce waste from medicines only taken when required, comparisons between homely medicine policy administration and ‘when required’ (PRN) prescription items and care home staff understanding of homely medicine policies.

Positive and negative attitudes towards homely medicine policies were evident within the data. This was not necessarily linked to the presence or absence of a policy within their organisation. There are several infrastructure, training and practical barriers which care homes face in order to utilise a homely medicine policy. These need to be weighed against the potential benefits, which here were highlighted as the potential to improve medication waste, but also improve access to medicines.