Misuse of insomnia medication most prevalent in older adults
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Key takeaways:
- A total of 69.5% of patients with insomnia aged 65 years and older were misusing medication.
- Extended duration was the most common inappropriate medication use category.
Inappropriate use of medication for insomnia was prevalent among adults in Canada, particularly those aged older than 65 years, with extended duration of use the most common reason and benzodiazepines the most common drug, new data show.
“Despite the existence of treatment guidelines, there is significant inappropriate medication usage of insomnia treatment,” Laveena Kamboj, MSc, senior director of value access and policy at Eisai Canada, a pharmaceutical company, and colleagues wrote in the Journal of Clinical Psychiatry. “Such as higher-than-recommended doses of sedative-hypnotics, long-term use of sedative-hypnotics, concurrent use with opioids and combination use of [central nervous system]-active drugs.”
Insomnia has been identified as an aggravating factor or comorbidity for a range of health conditions, and medications to treat the condition carry higher safety risks if guidelines are not followed properly, Kamboj and colleagues wrote.
They sought to examine real-world prescribing practices for those with insomnia in Canada, including medication utilization, potentially inappropriate medication use, associated costs and modes of treatment.
Their retrospective observational study included both private and public claims data between January 2018 and December 2020 taken from the Canadian IQVIA National Private Drug Plan and Ontario Drug Benefit databases. A total of 610,721 individuals in 2018, 597,222 in 2019 and 578,717 in 2020 with insomnia who made any claim related to medication were identified and included for analysis (average age, 55 years; 64% women; 70% aged 18 to 64 years).
Five medication classes were defined as interventions for insomnia (lemborexant [Dayvigo, Eisai], Z-drugs, benzodiazepines [BZD] antidepressants and antipsychotics) and four types of inappropriate medication utilization were defined: elevated daily dose; extended duration of use for BZD and/or Z-drugs; combination use; opioid overlap with BZD and/or Z-drugs.
According to the results, inappropriate medication use was noted in 52.5% of individuals aged 18 to 64 years and in 69.5% of those aged 65 years or older.
Inappropriate usage of medication increased throughout the claims analysis interval as well as the total cost of medication for insomnia ($56.7 million in 2018 to $57.7 million in 2020. More than half of the total cost each year was attributed to inappropriate use.
The researchers also found that extended duration was the most common inappropriate medication usage category, with BZD and Z-drugs the most common medications of misuse.
Data further showed that a higher proportion of those aged 65 years and older demonstrated inappropriate medication use for all 3 years (69% vs. 52.2% in 2018; 69.5% vs. 52.5% in 2019; 69.4% vs. 54.1% in 2020) compared with younger adults, with seniors also accruing higher cost proportion for inappropriate use compared with their younger counterparts.
“Overall, this study shows a need for better education to general practitioners and the public of current guidelines and more effective treatment options,” Kamboj and colleagues wrote. “As well as appropriate patient monitoring tools for physicians, particularly for seniors who may require long-term treatment.”