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The study looks at use of three classes of psychiatric drugs: antidepressants; sedatives, hypnotics and antianxiety medications; and antipsychotics.
Short acting hypnotics are preferable in patients with sleep onset insomnia, when sedation, the following day is undesirable or when prescribing for the elderly patients.
Although the new hypnotics are riot in the benzodiazepine class, they interact with the benzodiazepine receptor.
The associations held in separate analyses of several different hypnotics, including new short-acting hypnotics and older hypnotics, and after poor health was controlled for.
Rough order-of-magnitude estimates suggest that in 2010, hypnotics may have been associated with 320,000-507,000 ex cess deaths in the United States alone, the investigators reported.
Those drugs had been thought to be safer than older hypnotics because of their shorter duration of action.
A meta-analysis updated and expanded 22 previously published studies conducted between 1996 and 2007, involving falls among 79 081 participants aged over 60, and evaluated nine drug classes--antihypertensive agents, diuretics, beta-blockers, sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, narcotics, and non-steroidal anti-inflammatory drugs.
prescribing guidelines for hypnotics for depressed patients need an overhaul, according to John Donoghue, a research pharmacist at Liverpool (England) John Moores University.
As for informed consent, a useful strategy is to find out if someone else shares the patient's bed or bedroom, and to make sure he or she knows the risks of sedative hypnotics.
Short-acting hypnotics such as zolpidem (Ambien) or zaleplon (Sonata) are the preferred hypnotics in the elderly because of an improved side-effect profile compared with traditional hypnotics such as benzodiazepines (strength of recommendation: B, based on extrapolations of randomized controlled trials).
Keywords: ageing, epidemiology, hypnotics, incidence, insomnia