Long-Term Trends in Prescribing of Etizolam for Hypnotic Use in a Japanese University Hospital

Etizolam is a short-acting thienodiazepine widely prescribed for anxiety and insomnia despite increasing concerns regarding dependence and guideline recommendations limiting long-term benzodiazepine use. This study examined long-term prescribing trends of etizolam compared with benzodiazepine and non-benzodiazepine hypnotics.

We conducted a retrospective database study including 16,886,524 prescriptions issued between April 2001 and March 2022 at a tertiary university hospital in Japan. Seventeen hypnotic agents were identified (10 benzodiazepines and 7 non-benzodiazepines). Multivariable logistic regression was used to identify factors associated with prescribing hypnotic etizolam versus non-benzodiazepine hypnotics.

Among 124,179 etizolam prescriptions, 83,927 (67.6%) were issued for hypnotic use. Although the absolute number of prescriptions declined over time, the proportion prescribed for hypnotic use remained stable. The ratio of hypnotic etizolam prescriptions to non-benzodiazepine hypnotics was higher in internal medicine than in psychiatry. In multivariable analysis, prescribing hypnotic etizolam was independently associated with internal medicine (adjusted OR 1.57), female sex, outpatient status, younger age, and earlier calendar year.

Despite declining overall use, etizolam continues to be prescribed as a hypnotic, particularly in non-psychiatric settings. These findings highlight the persistence of specialty-specific prescribing patterns and underscore the importance of targeted educational and policy interventions to promote safer hypnotic prescribing practices.