Insomnia Drug Linked to Doubling of ED Visits

Deborah Brauser

August 15, 2014

New analysis from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that overmedicating with the insomnia drug zolpidem led to a near doubling of emergency department (ED) visits in the United States during the periods 2005-2006 and 2009-2010.

The new Drug Abuse Warning Network (DAWN) report from SAMHSA shows that there were 21,824 ED visits in the earlier time range vs 42,274 visits in the latter.

Although these types of visits increased between the 2 time ranges by 150% for men vs 69% for women, 68% of all zolpidem overmedication visits in 2010 were from women.

"Sleep aid medications can benefit patients, but they must be carefully used and monitored," said SAMSHA administrator Pamela S. Hyde in a release.

"Physicians and patients need to discuss the potential adverse reactions associated with any medication and work together to prevent problems or quickly resolve any that may arise," she added.

The DAWN report was released on SAMHSA's Web site August 7.

FDA Warnings

Zolpidem is approved by the US Food and Drug Administration (FDA) for short-term treatment of insomnia. It is also the active ingredient in several brand name sleep aids, including Ambien (sanofi-aventis), Edluar (Meda Pharmaceuticals, Inc), and Zolpimist (NovaDel Pharma, Inc).

Last year, because of numerous reports of adverse reactions from the ingredient, the FDA required companies manufacturing zolpidem-containing medications to lower the recommended dose by 50% for women. Although not a requirement, it also recommended that the dose be lowered for men.

Plus, "when zolpidem is combined with other substances, the sedative effects of the drug can be dangerously enhanced," writes SAMHSA in a release.

As reported by Medscape Medical News, another SAMHSA report released last week showed that 96% of ED visits in 2011 due to drug-related suicide attempts in those between the ages of 45 and 64 years involved over-the-counter medications and/or the nonmedical use of prescription drugs. Of these, 48% involved antianxiety and insomnia medications.

The new SAMHSA report is based on findings from DAWN reports released between 2005 and 2010.

It showed there were 4,916,328 drug-related ED visits in 2010, of which 20,793 were caused by zolpidem overmedication.

A total of 57% of the 2010 zolpidem overmedication-related visits involved other prescription drugs. Of these, 26% involved benzodiazepines, 25% involved narcotic pain relievers, 19% involved antidepressants, and 14% involved antipsychotics. A total of 14% of these ED visits were from a combination of zolpidem and alcohol.

Of all 2010 overmedication-related visits using zolpidem, 47% resulted in being admitted to a hospital or being transferred to another medical facility. A total of 26% of these resulted in admission to a critical care or intensive care unit.

The age range with the largest proportion of zolpidem-related ED visits in 2010 was between 45 and 54 years (31%). This was followed by those younger than 35 years (23%), those between the ages of 35 and 44 years (21%), those between the ages of 55 and 64 years (14%), and those older than 64 years (11%).

Finally, the number of these types of ED visits increased for men from 6607 in the 2005-2006 date range to 16,523 in 2009-2010 vs an increase for women from 15,216 to 25,749.

Preventing Overmedication

"Adults of all ages can help prevent overmedication by closely following the instructions for when and how to take all medications," the report notes.

"If symptoms persist when the recommended amount of zolpidem is taken, patients should consult their prescribing physician," they add.

SAMHSA notes that several major efforts are under way to promote prevention of prescription drug–related problems.

These include the organization's Strategic Prevention Framework Partnerships for Success II and the "Not Worth the Risk – Even If It's Legal" campaign, jointly created by SAMHSA and the National Council on Patient Information and Education.

"Enhancing drug safety is an important step toward improving public health and reducing health care costs," writes SAMHSA.

The new DAWN Report is posted on the SAMHSA Web site.

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