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Prescription patterns of hypnotics for children and adolescents in Japan: a descriptive epidemiologic study using a
Sachiko Tanaka-Mizuno1,2, Kenichi Fujimoto3, Kazuo Mishima4
1Laboratory of Epidemiology and Prevention, Kobe Pharmaceutical University, Kobe, Japan.
Insights
Melatonin was the most prescribed hypnotic for children, while melatonin receptor agonists (MRAs) and dual orexin receptor antagonists (DORAs) were also used in pediatric patients in Japan. Prescription patterns varied by age, suggesting age-specific treatment approaches for pediatric insomnia.
Area of Science:
- Pediatric pharmacology
- Sleep medicine
- Epidemiology
Background:
- Pediatric insomnia is a growing concern, necessitating understanding of current treatment practices.
- Hypnotic drug classes include melatonin, melatonin receptor agonists (MRAs), dual orexin receptor antagonists (DORAs), Z-drugs, and benzodiazepines.
- Prescription patterns for hypnotics in pediatric populations require detailed investigation.
Purpose of the Study:
- To investigate the prescription patterns of hypnotics in patients under 18 years old in Japan.
- To analyze the types of hypnotics, dosages, and prescription durations based on age groups.
- To identify common comorbidities associated with hypnotic prescriptions in pediatric patients.
Main Methods:
- A descriptive epidemiologic study utilizing a Japanese claims database.
- Inclusion criteria: patients aged 0-17 years with first-time hypnotic prescriptions from June 2021 to June 2023.
- Data analysis included hypnotic classification, dosage, duration, comorbidities, and concomitant medications, stratified by age.
Main Results:
- The study included 21,145 pediatric patients across four age groups (0-6, 7-11, 12-14, 15-17 years).
- Initial prescriptions: melatonin (33.9%), MRAs (30.9%), DORAs (18.8%), Z-drugs (10.1%), and benzodiazepines (6.3%).
- Melatonin was common in younger children (0-11 years), MRAs across all ages, and DORAs in adolescents (15-17 years). Autism spectrum disorder, depression, ADHD, and anxiety disorder were prevalent comorbidities.
Conclusions:
- Prescription patterns for hypnotics in pediatric patients in Japan demonstrate age-specific trends.
- Melatonin was prescribed longer for younger children, MRAs were used broadly, and DORAs were favored for adolescents.
- These findings suggest age-appropriate drug selection for pediatric insomnia, potentially linked to developmental stage and comorbid psychiatric disorders.
Study Objectives:
To investigate the prescription patterns for hypnotics among patients <18 years in Japan.
Methods:
We conducted a descriptive epidemiologic study using a claims database in Japan. We included patients aged 0-17 years with first-time prescriptions for hypnotics between June 2021 and June 2023. Hypnotics were classified as melatonin, melatonin receptor agonists (MRAs), dual orexin receptor antagonists (DORAs), Z-drugs, and benzodiazepines. We described the types of hypnotics, dosages, prescription duration, comorbidities, and concomitant medications for overall and by age groups.
Results:
The study included 21 145 patients; 1983 aged 0-6 years, 3901 aged 7-11 years, 6664 aged 12-14 years, and 8597 aged 15-17 years. The initial prescribed hypnotics were melatonin (33.9%), MRAs (30.9%), DORAs (18.8%), Z-drugs (10.1%), and benzodiazepines (6.3%). Melatonin was more likely to be prescribed to patients age 0-11 years, MRAs to those aged 0-17 years, and DORAs to patients ages 15-17 years. The most common mental health-related comorbidities were autism spectrum disorder (32.5%), depression (23.4%), attention-deficit hyperactivity disorder (19.8%), and anxiety disorder (18.2%).
Conclusions:
Melatonin was most frequently prescribed in children for a longer duration than other hypnotics, while MRAs were prescribed across all age groups and DORAs mainly to adolescents. These age-specific patterns suggest that the drug selection was conducted according to patient's age, since pediatric insomnia might be correlated with psychiatric disorders related to developmental stage. Future research should investigate the long-term effects of hypnotic prescriptions with consideration of comorbid conditions.
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