TY - JOUR
T1 - Chronic hypnotic use at 10 years—does the brand matter?
AU - Schonmann, Yochai
AU - Goren, Or
AU - Bareket, Ronen
AU - Comaneshter, Doron
AU - Cohen, Arnon D.
AU - Vinker, Shlomo
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Purpose: Chronic use of sedative-hypnotics is very common, although not guideline-endorsed. The incidence among new users is not well studied, and there are currently no recommendations favoring any specific agent. We quantified the risk for chronic use in first-time hypnotic users, and the association of the initial choice of hypnotic with later usage patterns. Methods: We used the computerized database of Israel’s largest healthcare provider. All 236,597 new users of sedative-hypnotics between the years 2000–2005 were followed for 10 years. Filled prescriptions in the second, fifth, and tenth years were recorded. The association of the first hypnotic choice (benzodiazepine/Z-drug) with chronic consumption was assessed using multivariate logistic regression. Results: Average age on first use was 63.7 (SD ± 16.4) years. 58.6% were women. Benzodiazepines were initiated in 154,929 (65.5%) of the cases. Benzodiazepine users were older and of lower socioeconomic status, compared to Z-drug users (p < 0.001). On the tenth year, 103,912 (66.8%) of new users claimed ≤ 30 DDDs of hypnotics, 3,1724 (20.4%) were long-term users (≥ 180 DDD/year), and 828 (0.5%) used excessively (≥ 720 DDD/year). Z-drugs were associated with an increased risk of long-term use on the second year [17.3% vs. 12.4%, RR = 1.40 (1.37–1.43)] as well as on the fifth [21.9% vs. 13.9%, RR = 1.58 (1.55–1.61)] and tenth year [25.1% vs. 17.7%, RR = 1.42 (1.39–1.45)], p < 0.0001. Similar results were also observed for daily and excessive use (p < 0.001). Conclusions: One in five new users of sedative-hypnotics will become a long-term user, but only 0.5% will become excessive users. Z-drugs were associated with an increased risk of chronic use.
AB - Purpose: Chronic use of sedative-hypnotics is very common, although not guideline-endorsed. The incidence among new users is not well studied, and there are currently no recommendations favoring any specific agent. We quantified the risk for chronic use in first-time hypnotic users, and the association of the initial choice of hypnotic with later usage patterns. Methods: We used the computerized database of Israel’s largest healthcare provider. All 236,597 new users of sedative-hypnotics between the years 2000–2005 were followed for 10 years. Filled prescriptions in the second, fifth, and tenth years were recorded. The association of the first hypnotic choice (benzodiazepine/Z-drug) with chronic consumption was assessed using multivariate logistic regression. Results: Average age on first use was 63.7 (SD ± 16.4) years. 58.6% were women. Benzodiazepines were initiated in 154,929 (65.5%) of the cases. Benzodiazepine users were older and of lower socioeconomic status, compared to Z-drug users (p < 0.001). On the tenth year, 103,912 (66.8%) of new users claimed ≤ 30 DDDs of hypnotics, 3,1724 (20.4%) were long-term users (≥ 180 DDD/year), and 828 (0.5%) used excessively (≥ 720 DDD/year). Z-drugs were associated with an increased risk of long-term use on the second year [17.3% vs. 12.4%, RR = 1.40 (1.37–1.43)] as well as on the fifth [21.9% vs. 13.9%, RR = 1.58 (1.55–1.61)] and tenth year [25.1% vs. 17.7%, RR = 1.42 (1.39–1.45)], p < 0.0001. Similar results were also observed for daily and excessive use (p < 0.001). Conclusions: One in five new users of sedative-hypnotics will become a long-term user, but only 0.5% will become excessive users. Z-drugs were associated with an increased risk of chronic use.
KW - (MESH)
KW - Adult
KW - Benzodiazepines
KW - Drug dependence
KW - Drug tolerance
KW - Hypnotics and sedatives
KW - Insomnia
KW - Risk
KW - Sleep initiation and maintenance disorders
KW - Zolpidem
KW - Zopiclone
UR - http://www.scopus.com/inward/record.url?scp=85051469296&partnerID=8YFLogxK
U2 - 10.1007/s00228-018-2531-4
DO - 10.1007/s00228-018-2531-4
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C2 - 30090968
AN - SCOPUS:85051469296
SN - 0031-6970
VL - 74
SP - 1623
EP - 1631
JO - European Journal of Clinical Pharmacology
JF - European Journal of Clinical Pharmacology
IS - 12
ER -