Strong sleeping pills known as “Z-drugs” may increase the risk of falls, fractures, and stroke among people with dementia, British researchers report.
People with dementia can have trouble sleeping and are often prescribed drugs such as zaleplon (Sonata), zolpidem (Ambien), and zopiclone to help them nod off, but higher doses of these drugs can have negative effects.
“As many as 90% of people with dementia suffer sleep disturbances and it has a big impact on their mental and physical health, as well as that of their carers,” said Chris Fox, from the University of East Anglia’s Norwich Medical School.
“Z-drugs are commonly prescribed to help people sleep. However, these medicines were never licensed for dementia, and they have been associated with adverse events such as falls and fracture risks in older people,” Fox said in a university news release.
For the study, the researchers collected data on more than 27,000 patients in England diagnosed with dementia between 2000 and 2016. Their average age was 83. More than 3,500 had been prescribed Z-drugs.
“We studied a range of adverse outcomes including fractures, falls, deep vein thrombosis [clots], stroke and death, over two years. And we were particularly interested to see whether higher doses led to worse outcomes,” Fox said.
“For patients prescribed Z-drugs, 17% were given higher doses. And we found that these patients on higher doses were more at risk of falls and fractures, particularly hip fractures, and stroke, compared with patients who were not taking any medication for sleep disturbance,” Fox said. These effects were not seen at low doses of the drugs.
“This research shows us that higher-dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered,” Fox said.
However, patients taking higher doses of these drugs shouldn’t stop taking them suddenly, but seek advice from their doctor, the researchers noted.
Higher-dose Z-drugs were defined as equivalent to 7.5 mg or higher of zopiclone. Zopiclone is no longer available in the United States.
The report was published online Nov. 24 in the journal BMC Medicine.