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Higher Doses of Z-Drugs Pose Risks for Dementia Patients

TUESDAY, Dec. 1, 2020 -- Among individuals with dementia, higher-dose Z-drug use is associated with an increased risk for fractures, falls, and ischemic stroke, according to a study published online Nov. 23 in BMC Medicine.

Kathryn Richardson, Ph.D., from the University of East Anglia in the United Kingdom, and colleagues examined the association between Z-drugs and adverse events among 27,090 patients diagnosed with dementia. Adverse events were compared for 3,532 patients newly prescribed Z-drugs by time-varying dosage to 1,833 non-sedative users with sleep disturbance; 10,214 non-sedative users with proximal general practitioner (GP) consultation matched for age, sex, and antipsychotic use; and 5,172 patients newly prescribed benzodiazepines.

The researchers found that 17 percent of the patients prescribed Z-drugs were initiated at higher doses. The hazard ratios for fractures, hip fractures, falls, and ischemic stroke were 1.67, 1.96, 1.33, and 1.88, respectively, for patients prescribed higher-dose Z-drugs relative to nonusers with sleep disturbance. Compared with non-sedative users with proximal GP consultation, similar associations were observed. At ≤3.75 mg zopiclone or equivalent daily, minimal or inconsistent excess risks were observed. The researchers did not observe any consistent or clinically excess risks for mortality, infection, or venous thromboembolism with Z-drug use. No differences were seen in adverse events for Z-drugs versus benzodiazepines, except mortality rates were lower with Z-drugs (hazard ratio, 0.73).

"Our findings serve an important caution regarding the harms of sleeping tablets in people with dementia," a coauthor said in a statement. "This research is a very timely and unfortunately necessary reminder that sedative medications are not a helpful way to manage social isolation during COVID-19."

Two authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

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Posted: December 2020

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