Z drugs may increase the risk of falls, fractures, and strokes in patients with dementia

Reviewed by Emily Henderson, B.Sc.November 24, 2020

Strong sleeping pills known as “Z drugs” are linked to an increased risk of falls, fractures and strokes among people with dementia – according to research from the University of East Anglia.

Sleep disturbances are common among people with dementia and the impact on patients and their families is significant.

To date, no proven effective treatments are available, however, people with dementia are often prescribed Z drugs (zopiclone, zaleplon, and zolpidem).

But a new study released today reveals that higher doses of these drugs are linked to an increased risk of adverse effects.

These adverse effects were similar or superior to those of higher-dose benzodiazepines or “gasolines,” which are also used to treat sleep disorders and are known to have several adverse effects.

The team says patients who are already taking higher doses of Z drugs should not stop taking the drugs suddenly, however they should ask for a review with their GP.

As many as 90% of people with dementia suffer from sleep disorders and this has a major impact on their mental and physical health, as well as that of their caregivers. Z drugs are commonly prescribed to help people sleep, however these drugs have never been licensed for dementia and have been associated with adverse events such as falls and fracture risk in older people. “

Chris Fox, professor, Norwich Medical School, University of East Anglia

“We wanted to find out how they affect people with dementia, who are often prescribed to help with sleep disorders.”

The team analyzed data from 27,090 patients in England diagnosed with dementia between January 2000 and March 2016. The mean age of the patients was 83 and 62% were women.

They looked at adverse events for 3,532 patients who had been prescribed Z drugs and compared them with people who had sleep disorders who had not been prescribed sedatives and patients who had been prescribed benzodiazepines.

They also looked to see if drug Z dosage played a role in the adverse outcomes.

Professor Fox said, “We have been studying a range of adverse outcomes including fractures, falls, deep vein thrombosis, stroke and death – for over two years. And we were particularly interested in seeing if higher doses led to worse outcomes.”

Z-drugs and higher-dose benzodiazepines were defined as prescriptions equivalent to ≥7.5 mg zopiclone or> 5 mg diazepam per day.

“For patients who were prescribed Z drugs, 17% received higher doses. And we found that these patients at higher doses were more at risk of falls and fractures, particularly hip fractures and stroke, than to patients who were not taking any medications for sleep disorders, “said Prof Fox.

However, those taking lower doses (≤3.75 mg zopiclone or equivalent) did not show an increased risk of adverse outcomes.

And there were no differences in adverse events for Z drugs compared to benzodiazepines, except for lower death rates with Z drugs.

The professor. Fox said, “This research shows us that higher-dose Z drugs should be avoided, if possible, in people living with dementia, and non-drug alternatives should preferentially be considered.

“Patients already taking Z drugs at higher doses should not stop taking the drugs, but it is recommended that they make an appointment to see their GP for a review,” he added.

Professor Clive Ballard, of the University of Exeter Medical School, who collaborated on the study, said, ‘Our findings serve an important caution regarding the harm of sleeping pills in people with dementia.

“This research is a very timely and sadly necessary reminder that sedative drugs are not a useful way to manage social isolation during Covid-19.

“Our study also highlights the importance of research in developing non-drug approaches to help people with dementia sleep, whether they are at home or in residential care.”

Dr Ian Maidment, Reader in Clinical Pharmacy at Aston University and lead pharmacist on the study said, “Z drugs are widely used to treat insomnia in people living with dementia, but are only recommended as a short-term treatment. for up to four weeks. Our work shows the importance of physicians, including primary care physicians and pharmacists, to examine patients on long-term Z-drugs. “

The study was conducted by UEA, in collaboration with researchers from the Quadram Institute, Aston University, University College London and the University of Exeter.

“ Adverse Effects of Z Drugs for Sleep Disorders in People Living With Dementia: A Population-Based Cohort Study ” was published in the journal BMC Medicine on November 24, 2020.