What If Miró’s Dots and Lines Are Not Simply Dots and Lines?

Abstract

showed the increased risks of falls related to zolpidem remained present even after adjusting for age. Similarly, we cited several other studies that included adult inpatients of all age groups. It may be reasonable to state that the adverse events associated with sedative-hypnotic medications, or the interventions suggested in these studies, lack ample evidence to extend to younger populations. However, as a corollary, there is also no physiological reason that risks or benefits would reverse in a younger population. Because we are recommending minimizing use of a medication that might increase risks (and is prescribed without appropriate indications in the first place), it is unlikely that deprescribing sedative-hypnotic medications will result in greater harm in younger populations. In fact, given that sedative-hypnotic coingestion is associated with increased lethality of opioid overdoses, it would be reasonable to anticipate harm reduction in any efforts and curb inappropriate sedative-hypnotic prescribing. We would welcome more evidence and study regarding the younger population.Regarding the association of zolpidem with complex and sometimes amnestic behaviors, there is sufficient validation of those adverse effects that a new black-box warning has been issued. 6 However, the cited article focuses on hypnotics in hospitalized patients, and our broad search strategy did not identify publications specifically addressing these complex behaviors in hospitalized patients. Nonetheless, we agree that caution is needed, carefully weighing risks and benefits prior to prescribing zolpidem. Additionally, if it must be prescribed, it should be at the minimal effective and approved dose.