Prescription sleeping tablets
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Options for prescription sleeping tablets

In one of my previous posts I analysed prescribing patterns for antidepressant drugs in UK, where sharp increase of antidepressant use in UK is seen. In today’s post I will be looking at prescribing statistics for prescription sleeping tablets, used for treatment of insomnia. Insomnia can be one of the symptoms of depression.

Does sharp increase of antidepressant prescribing correlate with increase use of prescription sleeping tablets in recent years?

Prescribing data used for this review was taken from OpenPrescribing.net

What are the recommendations for insomnia treatment?

Pharmacological treatment is not recommended as first line treatment of insomnia.

Hypnotics, the main class of drugs used in treatment of insomnia, are only recommended after appropriate hygiene advice is given to patients including CBT approach. However, if insomnia is severe for example causing distress or affecting day to day life short term (less than 4 weeks) pharmacological treatment may be recommended (NICE, 2015).

The main prescription drugs recommended for treatment insomnia include (ibid):

  • Short-acting benzodiazepines — temazepam, loprazolam, lormetazepam.
  • Non-benzodiazepines (the ‘z-drugs‘) — zopiclone, zolpidem, and zaleplon (all are short acting).

Tolerance (reduced effectiveness) to hypnotics can develop rapidly. Hypnotics may also cause dependence, rebound insomnia (symptoms of insomnia coming back after treatment is stopped) and a withdrawal syndrome (BNF, 2019). Because of that a short term use is only recommended.

Prescription sleeping drugs: statistics

Zopiclone is the most commonly prescribed hypnotic drug for sleeping with 5.2 mln prescriptions issued in 2018. Zopiclone is considerably more popular than any other sleeping drug available on prescription. Over last 4 years there were some fluctuations in prescribing of zopiclone, however since 2014 this number was always over 5 mln prescriptions per year and no significant decrease in prescribing can be seen.

Second most commonly prescribed drug for sleeping is temazepam with 0.99 mln presciptions issued for this drug in 2018. Prescribing of temazepam decreased significantly over last four years. This is manly due to reclassification of temazepam in 2015. Temazepam became Schedule 3 controlled drug in 2015.

Third most commonly prescribed drug for insomnia is melatonin. Melatonin is the only drug in the group of sleeping tablets where prescribing is on increase. The number of prescriptions issued for melatonin doubled since 2014 and last year this number was 0.9 mln prescriptions. Melatonin is available commonly over the counter without prescription in US, however in UK it is a prescription drug, and the only formulation available (Circadin 2 mg prolonged-release tablets) is licensed for the short-term treatment of insomnia in patients who are aged 55 or over.

None of the drugs above made it into Top 15 most prescribed drugs in UK in 2018.

Hypnotics prescribing 2014-2018 (items)
Drug 2014 2015 2016 2017 2018
Loprazolam 51,740 50,746 45,554 40,562 36,407
Lormetazepam 28,863 27,899 24,939 22,342 19,829
Melantonin 395,806 530,467 647,751 767,058 898,534
Nitrazepam 667,456 657,098 591,777 526,926 472,576
Temazepam 1,507,310 1,411,142 1,257,983 1,113,838 991,446
Zolpidem 669,106 725,127 716,144 686,199 658,068
Zopiclone 5,144,903 5,599,878 5,560,784 5,416,055 5,242,138

Overall there is no significant changes in prescribing of hypnotics for treatment of insomnia in last 4 years. Temazepam prescribing decreased significantly, but this was compensated with increase of melatonin prescribing.

This is a broad overview of prescribing of sleeping drugs in UK. Some drugs line diazepam were not included in this review. Diazepam is commonly prescribed drug in UK with 4.9 mln prescription issued in 2018. Diazepam can be prescribed for insomnia associated with anxiety, however its licensed for management on number of other conditions including severe anxiety, muscle spasm, cerebral palsy and others. Diazepam is not routinely recommended for treatment of insomnia, therefore analysis of its use as sleeping drugs is beyond the scope of this post.

Similarly, antidepressants drugs such as amitriptyline and mirtazapine are commonly used for treatment of depression where sedation is required. Both drugs were excluded from this analysis.

References:

BNF (2019). Hypnotics and anxiolytics. Available at: https://bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html Accessed on 11/04/2019

NICE (2015). Insomnia: Scenario: Managing short-term insomnia. Available at: https://cks.nice.org.uk/insomnia#!scenario Accessed on 11/04/2019

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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