Z-drugs and Falls: A Focused Review of the Literature

Abstract

OBJECTIVE: To provide a focused review of the literature related to the association between exposure to Z-drugs and the risk of falls, especially in the older population.<br/> DATA SOURCES: A literature search was conducted using Medline, PsychInfo, and the Cochrane Library database for all clinical trials, case series, and case reports published in English up to May 2020. The search terms used consisted of each Z-drug, including "zolpidem," "zopiclone," "eszopiclone," and "zaleplon," matched with "falls."<br/> STUDY SELECTION: The search yielded 295 studies. After review of abstracts, content and references were reviewed, and duplicates removed, a total of 9 articles met inclusion of exposure to at least 1 Z-drug and a primary outcome of falls.<br/> DATA EXTRACTION: The American Geriatrics Society 2019 Beers Criteria Update for Potentially Inappropriate Medication Use in Older Adults recommends to avoid using nonbenzodiazepine hypnotics in this patient population because of the risk of adverse events.<br/> DATA SYNTHESIS: A majority of the literature suggests an increased risk of falls with exposure to Z-drug use, especially zolpidem. Eight trials examined falls as a primary outcome in non-elderly (n=3) and elderly (n=5) patients in different settings, mostly in an inpatient setting (nursing facility or acute care hospital).<br/> CONCLUSION: Exposure to Z-drugs, especially zolpidem, should be evaluated and counseled on continuously as these medications put patients at an increased risk for falls and other complications.

Requests for Compensation in Cases Involving Patients’ Falls in Healthcare Settings: A Retrospective Analysis

“…Internationally, several studies have been conducted in order to identify preventive strategies, including educational initiatives aimed at optimizing drug therapies in hospital environments, such as the more cautious use of loop diuretics, digitalis and digoxin, betablockers, and the so-called "Z-drugs" (comprising zolpidem, zoplicone, eszoplicone, and zaleplon) [38,39]. In addition, although an association between depression and the risk of falls is postulated, some authors also reported a relationship between selective serotonin reuptake inhibitors (SSRIs) and an increased risk of falls [40,41].…”

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic

“…A despeito de ter um menor potencial de dependência, o uso dessa classe de medicamentos pode causar os mesmos efeitos adversos esperados para benzodiazepínicos. 19,20 Ademais, destaca-se que, recentemente a Food and Drug Administration (FDA) preconizou a inserção de informações nas caixas de medicamentos dessa classe (informação denominada Boxed Warning que apresenta destaque na embalagem de medicamentos dos Estados Unidos da América) referindo-se ao risco aumentado de lesões graves e morte em decorrência de comportamentos complexos do sono, incluindo sonambulismo. Esse efeito adverso pode ocorrer mesmo mediante uso de doses baixas, e até mesmo após o uso de apenas uma dose, com uso concomitante ou não de álcool ou outros depressores do sistema nervoso central.…”

“…Entretanto é importante destacar que esse resultado se limita a essa população específica e que outros estudos já identificaram tal associação em outros cenários. 19 Em relação ao desfecho fratura de fêmur, não se identificaram, na literatura, outros estudos longitudinais que investigaram sua associação com o uso de medicamentos sedativos entre pacientes idosos de um ambulatório de geriatria para fins comparativos. No presente estudo, o uso de sedativos e de benzodiazepínicos mostraram-se associados à incidência de fratura de fêmur no decurso de até 30 dias (OR = 2,57 para sedativos e OR = 3,45 para benzodiazepínicos).…”