The use of higher-than-recommended doses of zolpidem was commonly seen in women not previously treated with the drug, according to results from a study published in the Journal of Clinical Psychiatry.

Researchers conducted a retrospective cohort study of 139,525 people who had never been treated with zolpidem and were prescribed the drug from January 1, 2013, to June 3, 2014. Cohort data were obtained from a national pharmacy health administration database used by the Veterans Health Administration. High-dose zolpidem use was defined as more than 5 mg per day for women or 10 mg per day for men. The dosing definition was based on a safety warning released by the US Food and Drug Administration in 2013.

After statistical analysis, the researchers found that 0.4% of men (n=122,659) and 41.1% of women (n=16,866) were prescribed high-dose zolpidem therapy. In addition, they reported that substance abuse or dependence was associated with high-dose therapy in women (odds ratio, 1.20; P <.001).

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“The high prevalence of high-dose use in women is due in part to the change in the recommended dose for women,” the researchers wrote.

They went on to report that approximately 20% of veterans age 65 to 85 years receive long-term (treatment for a minimum of 180 days) zolpidem treatment. Both the presence of a psychiatric disorder (odds ratio 1.14 for women and 1.12 for men) and sleep disorder diagnosis (odds ratio 1.22 for women and 1.09 for men) were associated with long-term use.

“Efforts to improve access to effective nonpharmacologic treatment alternatives may benefit from attention to subpopulations with higher risk of high-dose and long-term use,” they concluded. Researchers mentioned cognitive behavioral therapy for insomnia as one such alternative but noted a shortage of trained providers.

Reference

Kim HM, Gerlach LB, Van T, Yosef M, Conroy DA, Zivin K. Predictors of long-term and high-dose use of zolpidem in veterans. J Clin Psychiatry. 2019;80(2):18m12149.