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    Research Letter
    September 2018

    Assessment of Patterns of Potentially Unsafe Use of Zolpidem

    Author Affiliations
    • 1Institute for Safe Medication Practices, Alexandria, Virginia
    • 2Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, Washington, DC
    • 3Risk Sciences International, Ottawa, Ontario, Canada
    JAMA Intern Med. 2018;178(9):1275-1277. doi:10.1001/jamainternmed.2018.3031

    Zolpidem was the most widely used prescription hypnotic medication and the fourth most frequently prescribed psychiatric drug in 2013.1 It achieves its effects as an agonist of γ-aminobutyric acid (GABA) receptors. However, the prescribing information2 and US Food and Drug Administration (FDA) Drug Safety Communications3 include limitations to reduce adverse effects, including (1) short-term use because of loss of efficacy; (2) a lower dose of 5 mg/d for those 65 years or older, and the lower starting dose for women because of 45% to 50% higher blood concentrations2; and (3) increased risks when combined with other central nervous system (CNS)-depressant drugs. These precautions were intended to reduce the risks of next-day impairment, abnormal behavioral changes, and dependency. We compared patterns of reported use with these recommendations in data from the largest publicly available national survey of prescription medication.