CHICAGO — Prescribing hypnotics such as zolpidem (multiple brands), zopiclon (Lunesta, Sunovion), or zaleplon (Sonata, Pfizer) to treat sleep problems in dementia patients significantly increases fracture risk in this vulnerable population, new research shows.
These so-called Z drugs were found to increase overall fracture risk by 40% and the risk for hip fracture by 59%.
“We are poisoning our patients” by overmedicating them, said study author Ian Maidment, PhD, senior lecturer in clinical pharmacy, Aston University, Birmingham, United Kingdom. “We need to find alternatives to drugs for treating sleep problems in people with dementia.”
The study was presented here at the Alzheimer’s Association International Conference (AAIC) 2018.
About 60% of people with dementia experience sleep disturbances, which can include insomnia and excessive daytime sleeping, Maidment said at a press briefing here.
Z drugs work in a manner similar to that of benzodiazepines and in many cases have replaced these drugs. In 2015, 3.8 million Americans were taking zolpidem, said Maidment.
About two thirds (64%) of older people in the United States are receiving high doses of zolpiden, a figure Maidment finds “shocking.”
Despite these drugs being widely used, there is concern that they may cause falls and fractures. However, little information is available on the safety of these hypnotics in patients with dementia, said Maidment.
To study this issue, investigators used the Clinical Practice Research Datalink, the most widely used clinical database in the United Kingdom. It houses primary care records and hospital data related to 13 million patients.
From this database, the researchers included patients who had been diagnosed with dementia and who had experienced a sleep disturbance. These patients were categorized into those who had received a Z-drug prescription (n = 2952) and those who had not (n = 1651). Maidment said these numbers illustrate how commonly used these drugs are in this patient population.
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