Chronic hypnotic use at 10 years—does the brand matter?

Yochai Schonmann*, Or Goren, Ronen Bareket, Doron Comaneshter, Arnon D. Cohen, Shlomo Vinker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1623-1631
Number of pages9
JournalEuropean Journal of Clinical Pharmacology
Volume74
Issue number12
DOIs
StatePublished - 1 Dec 2018

Keywords

  • (MESH)
  • Adult
  • Benzodiazepines
  • Drug dependence
  • Drug tolerance
  • Hypnotics and sedatives
  • Insomnia
  • Risk
  • Sleep initiation and maintenance disorders
  • Zolpidem
  • Zopiclone

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