Examining individual serotonin and norepinephrine reuptake inhibitors and fall-related hospitalizations in older adults

Abstract Introduction MDD is often managed with antidepressants that may carry a fall risk. Limited data exist comparing fall risk across individual SNRIs. Therefore, this study aimed to determine the fall rates associated with SNRIs. Methods Data were drawn from Merative MarketScan Medicare Supplemental claims (January 1, 2015 to November 30, 2021), including adults 65 years and older prescribed an SNRI (ie, duloxetine, venlafaxine, desvenlafaxine, milnacipran, levomilnacipran). The index date was the first prescription claim. Patients were followed up to 1 month after their last prescription to identify falls, using International Classification of Diseases (ICD) 9 th Revision and ICD-10 codes. Fall-related injuries were identified using trauma codes. Descriptive statistics and odds ratios (95% CI) were calculated to compare fall rates between agents. Propensity score weighting adjusted for potential selection bias. Results A total of 79 256 patients met eligibility (68% female; mean age: 75 years). Duloxetine (66%) and venlafaxine (30%) were the most prescribed. The overall fall rate was approximately 1% with duloxetine having the highest (1.1%), and venlafaxine having the lowest rate (0.68%). Injuries occurred in 79% of fall cases. After adjusting for age, sex, and comorbidities, the odds ratio for falling with venlafaxine versus duloxetine was 0.69 (95% CI = 0.56, 0.83), indicating a 31% odds reduction with venlafaxine compared with duloxetine. Discussion Venlafaxine appears to have a lower fall risk than duloxetine. Further studies are needed to determine clinical significance and assess fall-related costs to support safer SNRI use in older adults.