What's wrong with prescribing hypnotics?

@article{2004WhatsWW,
  title={What's wrong with prescribing hypnotics?},
  author={},
  journal={Drug and Therapeutics Bulletin},
  year={2004},
  volume={42},
  pages={89 - 93}
}
  • Published 1 December 2004
  • Medicine, Psychology, Political Science
  • Drug and Therapeutics Bulletin
Expert bodies have long advised that use of hypnotic drugs should be limited to short courses for acutely distressed patients and should generally be avoided in elderly people.1–3 Despite this, more than 10 million prescriptions for hypnotics continue to be dispensed each year in England alone, mostly for benzodiazepines and drugs with similar actions such as zaleplon, zolpidem and zopiclone (so called 'Z-drugs').4 Around 80% of all such prescriptions are for people aged 65 years or over,5 and… 
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References

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Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data.
TLDR
The findings offer the conclusion that zolpidem and zopiclone are relatively safe drugs, however, as both drugs are psychotropic drugs, patients with a history of abuse or dependence and those with psychiatric diseases seem to be at increased risk of abuse of these agents.
Limitations on the use of benzodiazepines in anxiety and insomnia: are they justified?
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Zolpidem dependence case series: possible neurobiological mechanisms and clinical management
TLDR
Molecular biology, via possible mutations on GABA receptors, may provide some answers as to why eight cases of zolpidem abuse and dependence without criminal record, without history of substance abuse, with minor psychiatric disorders, who took zolPidem after physicians prescription took it not craving its sedative, but its anxiolytic and stimulating action, which helped them to cope with everyday activities.
Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life
TLDR
Findings suggest that, taken long-term, BZDs do not aid sleep and produces some subtle cognitive advantages for older people, yet little in the way of withdrawal symptoms or emergent sleep difficulties.
Extent and appropriateness of benzodiazepine use
TLDR
Many older people still use benzodiazepines, contrary to official guidelines with regard to their mental health, and these findings add to the weight of opinion that persistent and long-term use should be discouraged.
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TLDR
Brief intervention, either in the form of the offer of a short consultation or a letter from the patient's GP, is effective in leading to reduced BZD intake without adverse consequences among long-term benzodiazepine (BZD) users.
Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation.
TLDR
The systematic review provided in this report suggests that an agnostic approach to cost-effectiveness is required for the use of hypnotic drugs for insomnia and it is suggested that further consideration should be given to a formal trial to allow head-to-head comparison of some of the key drugs in a double-blind RCT lasting at least 2 weeks, and of sufficient size to draw reasonable conclusions.
Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines.
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TLDR
The study indicates that some chronic users can successfully reduce their intake of benzodiazepines with simple advice from the general practitioner and a self-help booklet and this type of intervention does not lead to psychological distress or increased consultation.
Evaluation of an easy, cost-effective strategy for cutting benzodiazepine use in general practice.
TLDR
It is indicated that a simple intervention can have a considerable effect on the use of hypnotic and anxiolytic drugs, even with a sample of elderly users.
Zolpidem: an update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia.
TLDR
Although zolpidem produced some psychomotor and memory impairment over the first few hours after administration, it had few next-day effects and was comparable or superior to flunitrazepam and flurazep am and comparable to other benzodiazepines in patients with insomnia.
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