Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Abstract

This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

“… 67 The ranking results for somnolence or sedation are similar to those of death and may be explained by the fact that excessive sedation or sleep is associated with infection, including pneumonia, which could ultimately lead to death. 68 , 69 There is no evidence to support or justify the use of asenapine, clozapine, iloperidone, lurasidone, paliperidone, and ziprasidone given the lack of studies conducted on their use.…”

Benzodiazepine-Associated Carcinogenesis: Focus on Lorazepam-Associated Cancer Biomarker Changes in Overweight Individuals

“…Preclinical and animal research, randomized controlled trials, and epidemiological studies have all reported that benzodiazepines may increase the risk of carcinogenesis and cancer mortality [ 2 ]. Attention has been paid to whether differences exist in carcinogenic potential across different benzodiazepines [ 17 ].…”

“…These include daytime fatigue, decreased cognitive function, tolerance, dependence, impaired immune system, and increased risk of mortality. Benzodiazepine-associated excess mortality has been linked to the potential for carcinogenesis [ 2 ]. Preliminary evidence from animal studies suggested that benzodiazepines increased the risk of thyroid cancer [ 3 ] and liver cancer [ 4 ].…”

Alternative remedies for insomnia: a proposed method for personalized therapeutic trials

“…In fact, there is extensive literature documenting the acute and chronic adverse effects associated with hypnotic drugs, including those approved by the Food and Drug Administration (FDA) and those used off-label 7,10–13. Certain hypnotics may objectively worsen sleep: benzodiazepines might worsen breathing (although the evidence is inconsistent14) and antidepressants might increase periodic limb movements15 or worsen breathing in some circumstances 16.…”