Skip to main content
SpringerLink
Log in

Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Drugs prescribed for the treatment of insomnia can be either benzodiazepine hypnotics or the newer z-hypnotics, zopiclone and zolpidem. This paper explores possible explanations for the choice made.

Methods

Data from the Norwegian Prescription Database covering the entire population was studied for incident users of hypnotics. Possible predictors were age, gender, previous psychotropic or analgesic drug use and prescriber speciality.

Results

Of the 73,163 incident users of hypnotics, 3876 were prescribed benzodiazepine hypnotics in 2006. The strongest predictors for being prescribed benzodiazepines were previous use of anxiolytics [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7–2.0] and male gender (OR 1.5, 95% CI 1.4–1.6). Other significant predictors were antipsychotic or opioid drug use and the prescriber being a psychiatrist.

Conclusions

Z-hypnotics were commonly prescribed. Norwegian drug therapy recommendations also suggest a preference for z-hypnotics. The clear predominance of the shorter acting z-hypnotics may be due to the fact that only longer acting benzodiazepines are available in Norway. Reasons for prescribing benzodiazepines may be co-morbid psychiatric illness, such as anxiety, or a belief that benzodiazepine hypnotics are more effective than z-hypnotics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hollister LE (1983) The pre-benzodiazepine era. J Psychoactive Drugs 15:9–13

    PubMed  CAS  Google Scholar 

  2. Busto U, Lanctot KL, Isaac P, Adrian M (1989) Benzodiazepine use and abuse in Canada. Can Med Assoc J 141:917–921

    CAS  Google Scholar 

  3. Lader M (1991) History of benzodiazepine dependence. J Subst Abuse Tr 8:53–59

    Article  CAS  Google Scholar 

  4. Miller LG, Woolverton S, Greenblatt DJ, Lopez F, Roy RB, Shader RI (1989) Chronic benzodiazepine administration. IV. Rapid development of tolerance and receptor downregulation associated with alprazolam administration. Biochem Pharmacol 38:3773–3777

    Article  PubMed  CAS  Google Scholar 

  5. Paterniti S, Dufouil C, Alperovitch A (2002) Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 22:285–293

    Article  PubMed  CAS  Google Scholar 

  6. O’Hanlon JF, Vermeeren A, Uiterwijk MM, van Veggel LM, Swijgman HF (1995) Anxiolytics’ effects on the actual driving performance of patients and healthy volunteers in a standardized test. An integration of three studies. Neuropsychobiology 31:81–88

    Article  PubMed  CAS  Google Scholar 

  7. Hindmarch I, Fairweather DB (1994) Assessing the residual effects of hypnotics. Acta Psychiatr Belg 94:88–95

    PubMed  CAS  Google Scholar 

  8. Goa KL, Heel RC (1986) Zopiclone. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy as an hypnotic. Drugs 32:48–65

    Article  PubMed  CAS  Google Scholar 

  9. Girault C, Muir JF, Mihaltan F, Borderies P, De La Giclais B, Verdure A, Samson-Dollfus D (1996) Effects of repeated administration of zolpidem on sleep, diurnal and nocturnal respiratory function, vigilance, and physical performance in patients with COPD. Chest 110:1203–1211

    Article  PubMed  CAS  Google Scholar 

  10. Hajak G, Müller E, Wittchen HU, Pittrow D, Kirch W (2003) Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction 98:1371–1378

    Article  PubMed  CAS  Google Scholar 

  11. Dolder C, Nelson M, McKinsey J (2007) Use of non-benzodiazepine hypnotics in the elderly: are all agents the same? CNS Drugs 21:389–405

    Article  PubMed  CAS  Google Scholar 

  12. NOMESCO (2004) Medicines consumption in Nordic countries 1999–2003. Nordic Medico Statistical Committee, Copenhagen

    Google Scholar 

  13. Rønning M (2001) Drug consumption in Norway 1996–2000. Norwegian Medicinal Depot, Oslo

    Google Scholar 

  14. The Norwegian Medicines Agency (2008) Available at: www.legemiddelverket.no. Accessed 9 May 2008

  15. Walsh JK (2004) Drugs used to treat insomnia in 2002: Regulatory-based rather than evidence-based medicine. Sleep 27:1441–1442

    PubMed  Google Scholar 

  16. Furu K (2001) Drug utilisation in a public health perspective: Establishing a national prescription register in Norway. Nor J Epidemiol 11:55–60

    Google Scholar 

  17. Furu K, Strøm H, Rønning M, Skurtveit S, Engeland A, Tverdal A (2005) The Norwegian Prescription Database (NorPD): new register for pharmacoepidemiological research covering a whole nation. Pharmacoepidemiol Drug Saf 14:S48

    Google Scholar 

  18. The Norwegian Prescription Database (2008) Available at: http://www.norpd.no. Accessed 9 May 2008

  19. Griffiths RR, Weerts EM (1997) Benzodiazepine self-administration in humans and laboratory animals - implications for problems of long-term use and abuse. Psychopharmacology 134:1–37

    Article  PubMed  CAS  Google Scholar 

  20. Statistics Norway (2006) Available at: http://www.ssb.no. Accessed 9 May 2008

  21. WHO (World Health Organization) Collaborating Centre for Drug Statistics Methodology (2005) Guidelines for ATC classification and DDD assignment. WHO, Oslo

    Google Scholar 

  22. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WA (2004) Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 420:55–64

    PubMed  Google Scholar 

  23. Montplaisir J, Hawa R, Moller H, Morin C, Fortin M, Matte J, Reinish L, Shapiro CM (2003) Zopiclone and zaleplon vs benzodiazepines in the treatment of insomnia: Canadian consensus statement. Hum Psychopharmacol 18:29–38

    Article  PubMed  CAS  Google Scholar 

  24. National Institute of Clinical Excellence. Technology Appraisal Guidance 77 (2004) Guidance on the use of zaleplon, zolpidem and zopiclone for the short term management of insomnia. Available at: http://www.nice.org.uk. Accessed 9 May 2008

  25. Terzano MG, Rossi M, Palomba V, Smerieri A, Parrino L (2003) New drugs for insomnia. Comparative tolerability of zopiclone, zolpidem and zaleplon. Drug Safety 26(4):261–282

    Article  PubMed  CAS  Google Scholar 

  26. Mahomed R, Paton C, Lee E (2002) Prescribing hypnotics in a mental health trust: what consultant psychiatrists say and what they do. Pharmaceutic J 268:657–659

    Google Scholar 

  27. Clark RE, Xie HG, Brunette MF (2004) Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry 65:151–155

    Article  PubMed  Google Scholar 

  28. Miller NS (1995) Pharmacotherapy in alcoholism. J Addict Dis 14:23–46

    Article  PubMed  CAS  Google Scholar 

  29. Isacson D, Bingefors K, Wennberg M, Dahlström M (1993) Factors associated with high-quantity prescriptions of benzodiazepines in Sweden. Soc Sci Med 36:343–351

    Article  PubMed  CAS  Google Scholar 

  30. Wazana A (2008) Physicians and the pharmaceutical industry. Is a gift ever just a gift? JAMA 283:373–380

    Article  Google Scholar 

  31. Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM (1993) Primary non-compliance with prescribed medication in primary care. Br Med J 307:846–848

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the Norwegian Foundation for Health and Rehabilitation as well as the Norwegian Council for Mental Health for financing the work of AMH.

Author information

Authors and Affiliations

  1. Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway

    Anne M. Hausken, Kari Furu, Svetlana Skurtveit, Anders Engeland & Jørgen G. Bramness

  2. Department of Public Health and Primary Health Care, Section of Epidemiology and Medical Statistics, University of Bergen, Bergen, Norway

    Anders Engeland

  3. Department of Pharmacy, University of Tromsø, Tromsø, Norway

    Svetlana Skurtveit

Authors
  1. Anne M. Hausken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kari Furu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Svetlana Skurtveit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anders Engeland
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jørgen G. Bramness
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne M. Hausken.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hausken, A.M., Furu, K., Skurtveit, S. et al. Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors. Eur J Clin Pharmacol 65, 295–301 (2009). https://doi.org/10.1007/s00228-008-0565-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-008-0565-8

Keywords

Search

Navigation