‘Z’‐hypnotics versus benzodiazepines for the treatment of insomnia

Agravat, Aasha

doi:10.1002/pnp.502

Cited by 13 publications

(18 citation statements)

References 12 publications

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“…25 Although BZD use has been linked with adverse health outcomes, z-dugs were thought to have a good safety profile due to a shorter half-life and lower residual drowsiness. 26 However, long-term use of z-drugs is also associated with negative consequences. 9,10 Evidence about drug prescribing for insomnia usually come from either small surveys or studies using drug dispensing data.…”

Section: Introductionmentioning

confidence: 99%

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

et al. 2021

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Background: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs often used for managing insomnia. Aim: To explore changes in the pattern of benzodiazepine (BZD), z-drugs (zolpidem, zopiclone) and non-BZD prescriptions. Design and Setting: Open cohort study including 1,773,525 patients (55,903,294 consultations) regularly attending 404 Australian general practices from 2011-2018 (MedicineInsight). Method: Prescription rates per 1,000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent recorded insomnia diagnosis (i.e. within 2 years) were analysed using adjusted regression models. Results: Rates of BZD, z-drugs and non-BZD prescriptions were 56.6, 4.4 and 15.5/1,000 consultations in 2011 and 41.8, 3.5 and 21.5/1000 consultations in 2018, respectively. Temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined from 2011-2018 [annual change varying from -1.4% to -10.8%], while non-BZD and zopiclone prescriptions increased in the same period [annual change: +5.0% to +22.6%]. Repeat prescriptions above recommendations remained below 10% for most medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%) and alprazolam (13.3%). In 2018, almost 50% of z-drugs and melatonin prescriptions were for patients with insomnia. There was 3.2%-5.9% annual increase in the proportion of prescriptions associated with a recently recorded insomnia diagnosis. Conclusion: Overall, BZD prescriptions in Australia declined from 2011-2018. However, the prescription of some of these drugs increased for patients with a recently recorded insomnia diagnosis. This is concerning because of potential adverse effects and risk of dependence.

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Section: Introductionmentioning

confidence: 99%

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

et al. 2021

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“…The present analysis, thus, suggests that administration of ramelteon at least 1 h before bedtime is beneficial in terms of improving ISI score. The recommendation for benzodiazepines and non-benzodiazepines is to take these drugs just before bedtime due to safety concerns including amnesia, altered state of consciousness, somnambulism, and hypotonia, which may lead to falls [5,6]. Because information on the timing of the onset of AEs was not collected in the present study, we could not assess whether dosing timing of ramelteon was associated with any safety concerns.…”

Section: Discussionmentioning

confidence: 95%

“…Benzodiazepine receptor agonists bind to the gamma-aminobutyric acid (GABA) A receptor and exert sedative, anticonvulsant, and anxiolytic effects, which result in a potent hypnotic effect [4]. However, benzodiazepine receptor agonists are associated with adverse drug reactions (ADRs), such as muscle relaxation, rebound insomnia, amnesia, and withdrawal symptoms [5,6], which may detrimentally affect patient HRQL [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of ramelteon on insomnia severity: evaluation of patient characteristics affecting treatment response

Uchiyama

Sakamoto

Miyata

2019

Sleep Biol. Rhythms

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We conducted a multicenter, open-label, observational study to evaluate the effectiveness and safety of ramelteon in patients with insomnia, and patient characteristics affecting treatment response in routine clinical practice. Eligible patients were aged ≥ 20 years, had a diagnosis of insomnia with difficulty falling asleep, and were scheduled to receive ramelteon 8 mg/day for 12 weeks. The primary objective was to evaluate the relationship between changes in insomnia severity [measured by the Insomnia Severity Index (ISI)] and patient characteristics. Changes in the physical (PCS-8) and mental (MCS-8) components of the Short Form-8 (SF-8), and safety were also investigated. 1527 patients received therapy; 40.5% were aged ≥ 65 years and 29.7, 56.9, and 13.4% had mild, moderate, or severe insomnia, respectively. At week 12, significant improvements in ISI score [mean change (standard deviation) from baseline, − 5.0 points (6.3); p < .0001], PCS-8 score [+ 2.40 points (8.71); p < .0001], and MCS-8 score [+ 3.68 points (9.47); p < .0001] were observed. Factors affecting ISI response or remission (based on adjusted odds ratios) included age ≥ 75 years, shorter disease duration, no alcohol intake, being employed full time, not taking concomitant medication for insomnia, and taking ramelteon more than 1 h before bedtime. In total, 5.9% of patients reported adverse drug reactions. In routine clinical practice, 12 weeks' therapy with ramelteon was effective at improving insomnia severity, with no new safety concerns identified. Several patient characteristics were found to influence response to therapy. Clinical trial identifier: UMIN000013271

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“…Unlike the other Z-drugs, zolpidem has a greater ability to cause tolerance and dependence, and its spectrum of adverse events is comparable to BDZs when it is taken at higher doses than recommended, for long term treatments, or chronically as self-medication [40]. Additionally, zolpidem can be associated with complex behaviors and paradoxical reactions such as sleepwalking, sleep-driving, hallucinations, hyperactivity, vivid dreams, sexual disinhibition, anxiety and aggression [41].…”

Section: Z-drugs Structure and Binding Activitymentioning

confidence: 99%

BDZs, Designer BDZs and Z-drugs: Pharmacology and Misuse Insights

Zaami

Graziano

Tittarelli

et al. 2022

CPD

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: Benzodiazepines (BZDs) are a widely prescribed class of sedative-hypnotics compounds for the treatment of a broad range of conditions as anxiety and obsessive-compulsive disorders, phobias, sleep related problems associated with insomnia and for the management of alcohol and GHB withdrawal. Zolpidem, zopiclone and zaleplon, commonly known as Z-drugs are non-benzodiazepine hypnotic drug with pharmacology similar to BDZs. Despite their usefulness, BDZs and Z-drugs present a potential for abuse and dependence. Moreover, the non-medical use of BDZs is a well-known phenomenon and represents an increasingly widespread public health problem since is associated with an elevated risk of serious health consequences or fatal overdose, especially among specific group of users. The spectrum of BDZs and Z-drugs misuse is extended by new synthetic BDZs, which may pose high risks to users, since the majority have never undergone clinical trials or tests and consequently their pharmacology and toxicology is largely unknown.

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‘Z’‐hypnotics versus benzodiazepines for the treatment of insomnia

Cited by 13 publications

References 12 publications

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

Effect of ramelteon on insomnia severity: evaluation of patient characteristics affecting treatment response

BDZs, Designer BDZs and Z-drugs: Pharmacology and Misuse Insights

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