'Hypnotic' prescription patterns in a large managed-care population

Medical treatment of insomnia has declined over the past decade and, when treated, use of non-hypnotic medications has increased. This study assessed the characteristics of the prescriptions for insomnia and of the patients receiving those prescriptions.

The outpatient pharmacy database of the Henry Ford Hospital, Health Alliance Plan (HAP) was searched from 1/1/98 to 6/30/99 for mentions of the 10 most frequently used drugs for the treatment of insomnia listed in the National Disease and Therapeutic Index for 1987-1996. The 10 drugs were alprazolam, amitriptyline, clonazepam, doxepin, flurazepam, lorazepam, temazepam, trazodone, triazolam, and zolpidem. These were classified by their indication as antidepressant, anxiolytic, or hypnotic and the three indication groupings were compared on patient and prescription characteristics.

Over the 18 month period the total patient population covered by HAP was 287,456; 20,014 (7%) patients received one or more prescriptions for insomnia. Of these, anxiolytics were most frequently prescribed (55%), then antidepressants (25%), and hypnotics least frequently (20%). Patients receiving hypnotics were more likely to be male, older, and to receive a narrower dose range, in smaller quantities and with fewer refills than patients receiving anxiolytics or antidepressants.

In this large managed-care population, hypnotics are prescribed conservatively, while the non-hypnotics, for which there is limited efficacy and safety data, are prescribed on a more chronic basis.