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Meta-analyses of hypnotics and infections: eszopiclone, ramelteon, zaleplon, and zolpidem

Florendo L Joya1, Daniel F Kripke, Richard T Loving

  • 1Scripps Clinic Sleep Center, La Jolla, CA 92037, USA.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|December 9, 2009
PubMed
Abstract

Insights

This study found that hypnotics, including eszopiclone and zolpidem, may increase infection risk. Further research is needed to confirm this link and explore potential causes like immune compromise.

Area of Science:

  • Pharmacology and Therapeutics
  • Infectious Diseases Epidemiology

Background:

  • Recent meta-analyses have highlighted potential risks associated with hypnotic medications.
  • Preliminary data suggests a possible association between eszopiclone use and an increased incidence of infections.

Purpose of the Study:

  • To investigate the risk of infections associated with the use of four recently approved hypnotics.
  • To clarify the safety profile of hypnotics concerning infection risk through meta-analysis of controlled trials.

Main Methods:

  • A meta-analysis was conducted on data from US Food and Drug Administration files and published studies.
  • Included were controlled clinical trials of eszopiclone, ramelteon, zaleplon, and zolpidem, comparing hypnotic users to placebo groups.
  • Risk ratios for infection development were calculated for hypnotic versus placebo exposure.

Main Results:

  • A statistically significant increased risk of infections was observed in participants taking hypnotics compared to placebo (risk ratio = 1.44, p < 0.00001).
  • The majority of reported infections were mild and did not result in study withdrawal.
  • Individual drug analyses indicated that eszopiclone and zolpidem were associated with higher reported infection rates; data for zaleplon and ramelteon were insufficient for separate meta-analysis.

Conclusions:

  • The findings suggest a potential link between hypnotic use and an increased risk of infections, warranting further objective investigation.
  • Potential mechanisms, such as immune compromise or esophageal reflux and aspiration, should be explored in future research.

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