University of Michigan, 3550 Rackham, Ann Arbor, MI 48109-1070.
Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, Michigan, USA.
J Clin Psychiatry. 2019 Feb 5;80(2):18m12149. doi: 10.4088/JCP.18m12149.
Prescriptions for sedative hypnotics are routinely initiated and renewed to treat insomnia, despite evidence supporting nonpharmacologic treatments as comparable and more favorable over time. We used national Veterans Health Administration data to assess patient characteristics associated with high-dose and long-term zolpidem use.
The study included outpatients with new zolpidem prescriptions (January 1, 2013, to June 3, 2014). We defined high-dose use as use of doses above those recommended in the 2013 FDA safety warning (> 5 mg for women, > 10 mg for men) and defined long-term use as at least 180 days of continued supply. We fit separate logistic regression models by sex to evaluate how patient factors, adjusting for facilities, predicted high-dose and long-term use.
Of 139,525 new zolpidem users, < 1% of men and 41% of women used high doses within 180 days of initiation, and 20% continued to use zolpidem long-term. Prior-year use of other sleep medications was associated with both high-dose and long-term use. Substance abuse/dependence was associated with high-dose use in women (odds ratio = 1.20, P < .001). Although long-term use was less likely in those over the age of 85 years, about 1 in 5 users aged 65 to 85 continued long-term. In both sexes, individuals of Hispanic ethnicity and nonwhite races were less likely to use long-term, whereas those with ICD-9-CM-defined psychiatric and sleep disorder diagnoses were more likely to use long-term.
Zolpidem use at a higher-than-recommended dose was common in women who were new zolpidem users. In both sexes, 1 in 5 users continued to use zolpidem for at least 180 days. Efforts to improve access to effective nonpharmacologic treatment alternatives may benefit from attention to subpopulations with higher risk of high-dose and long-term use.
尽管有证据表明非药物治疗在一段时间内具有可比性且更有利，但镇静催眠药物的处方仍被常规用于治疗失眠。我们使用国家退伍军人健康管理局的数据评估与高剂量和长期使用唑吡坦相关的患者特征。
该研究纳入了 2013 年 1 月 1 日至 2014 年 6 月 3 日期间新开具唑吡坦处方的门诊患者。我们将高剂量定义为使用剂量超过 2013 年 FDA 安全警告中推荐的剂量（女性> 5 毫克，男性> 10 毫克），并将长期使用定义为至少 180 天的持续供应。我们通过性别分别拟合逻辑回归模型，评估患者因素（调整设施因素）如何预测高剂量和长期使用。
在 139525 名新使用唑吡坦的患者中，不到 1%的男性和 41%的女性在开始使用后 180 天内使用高剂量，20%的患者继续长期使用唑吡坦。前一年使用其他睡眠药物与高剂量和长期使用均相关。药物滥用/依赖与女性高剂量使用相关（比值比= 1.20，P <.001）。尽管年龄超过 85 岁的患者长期使用的可能性较低，但仍有约 1/5 的 65 至 85 岁患者长期使用。在两性中，西班牙裔和非白色种族的个体更不可能长期使用，而 ICD-9-CM 定义的精神和睡眠障碍诊断的个体更有可能长期使用。
在新使用唑吡坦的女性中，使用高于推荐剂量的唑吡坦很常见。在两性中，1/5 的患者继续使用唑吡坦至少 180 天。为改善有效非药物治疗替代方案的可及性，可能需要关注高剂量和长期使用风险较高的亚人群。
