Adverse events with Z-drugs in patients with dementia
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Adverse events with Z-drugs in patients with dementia When used at higher doses in patients living with dementia (PLwD), the Z-drugs [zaleplon, zopiclone, zolpidem] appear to be associated with a risk of fracture or stroke which is similar to or even greater than that for benzodiazepines, according to study results reported in BMC Medicine. The study* used data from 27 090 patients diagnosed with dementia in the UK between January 2000 and March 2016, divided into cohort studies. Adverse events in patients with sleep disturbance who were newly prescribed Zdrugs were compared with patients newly prescribed benzodiazepines, patients with sleep disturbance not prescribed sedatives, and matched patients with proximal GP consultations who were not prescribed sedatives. Most Z-drug recipients received zopiclone (95%), while the most frequently prescribed benzodiazepines were diazepam (40%), lorazepam (32%) and temazepam (23%). For Z-drug recipients, there was an increased risk of fracture compared to patients with sleep disturbances (hazard ratio [HR] 1.34; 95% CI 0.99, 1.75) or patients with proximal GP consultations (HR 1.34; 1.08, 1.67). There were similar results for hip fractures (HR 1.38; 0.92, 2.06 vs HR 1.59; 1.15, 2.19, respectively). For falls, there was a higher risk compared to patients with proximal GP consultations (HR 1.43; 1.26, 1.62), but not compared to patients with sleep disturbance. In the 17% of patients who received higher doses of Z-drugs (≥7.5mg zopiclone equivalent daily), risks were higher than patients with sleep disturbance for fractures (HR 1.67; 1.13, 2.46), hip fractures (HR 1.96; 1.16, 3.31) and falls (HR 1.33; 1.06, 1.66); similar associations were found compared to patients with proximal GP consultations. Higher doses were also associated with an increased risk of ischaemic stroke, both in patients with sleep disturbance (HR 1.88; 1.14, 3.10) and patients with proximal GP consultations (HR 1.90; 1.30, 2.79). This appeared to be greater than that for higher dose benzodiazepine use (HR 1.37; 091, 2.08). "Higher doses of Z-drugs should be avoided in PlwD", note the authors, "due to increased fracture and stroke risks," and "prescribers should use the lowest effective dose". In addition, "our findings suggest that the safety profile of Zdrugs should be considered similar to benzodiazepines in PlwD". * EUPAS18006 Richardson K, et al. Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study. BMC Medicine : 24 Nov 2020. 803519791 Available from: URL: https://doi.org/10.1186/s12916-020-01821-5
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Reactions 5 Dec 2020 No. 1833
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