Catching some zzz’s with Z-drugs? You might want to reconsider

Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike. A team of researchers from the Hebrew University of Jerusalem’s School of Pharmacy, led by Dr Amichai Perlman and Nir Treves, and directed by Dr Ilan Matok, therefore undertook a meta-analysis project aimed at systematically searching, evaluating, and analyzing, all available studies reporting on the risk of fractures, falls, and injuries with Z-drugs.

After combing through over 2,000 published articles, the researchers found ten observational studies which reported on the risk of fractures among over 145,000 participants using Z-drugs. While not all of the studies were conclusive, each of the studies suggested Z-drugs increased the risk of fractures. A statistical analysis pooling the results of these studies demonstrated that Z-drugs were associated with a significant 1.63-fold increase in the odds of fractures.

Far fewer studies were available to evaluate the risk of injuries and falls with Z-drugs. However, the available data indicated a two-fold increase in the odds of injuries as well.

The results of this meta-analysis suggest Z-drugs are associated with an increased risk for fractures and injuries. This risk could be the result of Z-drugs’ effects on cognitive and motor function, which could lead to an increase in the risk of falls and other accidents. As the studies included in this meta-analysis were all observational, the possibility that these results were driven by other differences between Z-drug users and non-users could not be ruled out with certainty. However, the meta-analysis describes several measures taken to evaluate this possibility. Physicians should therefore consider these potential risks before prescribing these medications in older adults. Guidance from NICE recommends Z-drugs should only be prescribed for the management of severe insomnia interfering with normal daily life, after considering the use of non-pharmacological measures, and for short periods only.

The full systematic review Z-Drugs and Risk for Falls and Fractures in Older Adults – a Systematic-Review and Meta-analysis can be read in full on the Age and Ageing journal website.

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