Published: December 2010

Publications

Hypnotics and anxiolytics - a wake-up call

This article is more than five years old. Some content may no longer be current.

Prescriber Update 31(4): 34
December 2010

A recently released coroner's report serves as a reminder to all healthcare professionals that the use of benzodiazepines and other hypnotics needs careful consideration when used for the treatment of insomnia.

Importantly, the duration of use and dose of hypnotics and benzodiazepines should be limited to a short course of treatment with regular review.

Insomnia is distressing for the patient and can be challenging for healthcare professionals to treat. Before considering pharmacological treatment for insomnia other possible causes should be excluded.

If pharmacological treatment is initiated, a short-acting benzodiazepine or other hypnotic such as zopiclone can be used in the short-term. Patients should be given the lowest effective dose for the shortest possible time; regular review should include careful consideration of the need for ongoing treatment. Patients should also be informed about some of the less well known effects such as sleep walking and other dissociative behaviour e.g. sleep eating.

Patients who are treated long-term with benzodiazepines and other hypnotics for insomnia should be encouraged to gradually withdraw treatment. Slowly tapering the dose over a number of months may help to reduce the withdrawal effects such as agitation, anxiety and insomnia.

Further information on the treatment of insomnia, guidance on the safe prescribing of pharmacological treatment, and advice on withdrawing patients from long-term treatment is provided in the list of references below.^1-5

Further information on the use of benzodiazepines and other hypnotics for the treatment of insomnia can also be found in the product data sheets at: www. medsafe.govt.nz/Medicines/infoSearch.asp

References

1. Tiller JWG (2003) The management of insomnia: an update. Australian Prescriber. Available at: http://www.australianprescriber.com/magazine/26/4/78/81/ Accessed 24 November 2010.
2. Schutte-Rodin S, Broch L, Buysse D et al. 2010 Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine 4(5) 487-504.
3. BPAC (2008) Managing insomnia. Best Practice Journal. Issue 14. http://www.bpac.org.nz/magazine/2008/june/insomnia.asp Accessed 24 November 2010.
4. RANZCP (2008) Guidelines for use of benzodiazepines in psychiatric practice. Practice Guideline #5. Available at: http://www.ranzcp.org/images/stories/ranzcp-attachments/Resources/College_Statements/Practice_Guidelines/pg5.pdf Accessed 24 November 2010. 5. Therapeutic Guidelines Inc.
5. Therapeutic Guidelines: Psychotropic Version 5 2003, Melbourne, Australia