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

Area of Science:

• Pharmacology
• Public Health
• Clinical Medicine

Background:

• Chronic sedative-hypnotic use is prevalent but not guideline-recommended.
• The incidence of long-term use among new users is understudied.
• No specific hypnotic agent is favored by current recommendations.

Purpose of the Study:

• To quantify the risk of chronic sedative-hypnotic use in first-time users.
• To assess the association between the initial hypnotic choice and subsequent usage patterns.

Main Methods:

• A 10-year follow-up study of 236,597 new sedative-hypnotic users (2000-2005) from Israel's largest healthcare provider.
• Prescription data from the second, fifth, and tenth years were analyzed.
• Multivariate logistic regression evaluated the link between initial hypnotic choice (benzodiazepine vs. Z-drug) and chronic consumption.

Main Results:

• The average age of new users was 63.7 years, with 58.6% being women.
• Long-term use (≥180 DDD/year) was observed in 20.4% by the tenth year; excessive use (≥720 DDD/year) in 0.5%.
• Z-drug initiators showed a significantly increased risk for long-term use compared to benzodiazepine users across all follow-up years (RR 1.40-1.58, p<0.0001).

Conclusions:

• Approximately 20% of new sedative-hypnotic users transition to long-term use.
• Excessive use of hypnotics remains uncommon, affecting only 0.5% of new users.
• Initiating treatment with Z-drugs is associated with a higher risk of developing chronic hypnotic use.