CLINICAL EPIDEMIOLOGY OF THE EFFECT OF NOVEL HYPNOTICS ON PRESCRIBING CHANGES IN PATIENTS USING BENZODIAZEPINE RECEPTOR AGONISTS

Abstract Background Insomnia is one of the most common disorders in the general population. Although non- pharmacologic interventions are the first-line treatment in many cases[1], pharmacotherapy is an important option in treatment. Because of the risk of various adverse events associated with benzodiazepine receptor agonists (BZRAs)[2], the use of newer hypnotics that target orexin and melatonin (novel hypnotics) has been recommended in recent years[3]. In the present study, we investigated the change in prescriptions of patients prescribed BZRAs after the initiation of the novel hypnotics. This study was approved by the institutional review boards of the participating institutions. Methods Changes in prescriptions after the initiation of novel hypnotics were investigated in patients who were prescribed both BZRAs and novel hypnotics who visited the outpatient clinics of all departments of the two general hospitals between May 01, 2021 and April 30, 2022. Results We enrolled 534 patients in this study. The mean (SD) age was 58.5 (18.1) and 300 (56%) were female. About half of the prescriptions (297/610) were made by non-psychiatric departments. The most commonly prescribed drugs in the BZRAs were brotizolam (13%, 172/1290) and eszopiclone (11%, 138/1290); the most commonly prescribed novel hypnotic was suvorexant (22%, 282/1290). The mean number of drugs prescribed before and after the addition of novel hypnotics was 1.7 (SD: 0.6), respectively, and 17% (90 patients) had a decrease in the number of medications, while 15% (82 patients) had an increase in the number of medications. Conclusion In the present study, no change in the number of medications was observed as a result of the initiation of novel hypnotics in patients prescribed BZRAs. Future studies should investigate which patients succeed/fail in reducing their medications and how this relates to patient background: References [1]Sateia MJ et al. Clinical Practice Guideline for the Pharmacologic Treatment of ChronicInsomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 2017. [2]Hirschtritt ME et al. Balancing the Risks and Benefits of Benzodiazepines. JAMA, 2021. [3]Neubauer DN. Pharmacotherapy for insomnia in adults. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.(Accessed on December 16, 2023.)