European Journal of Clinical Pharmacology

, Volume 74, Issue 12, pp 1623–1631 | Cite as

Chronic hypnotic use at 10 years—does the brand matter?

  • Yochai SchonmannEmail author
  • Or Goren
  • Ronen Bareket
  • Doron Comaneshter
  • Arnon D. Cohen
  • Shlomo Vinker
Pharmacoepidemiology and Prescription



Chronic use of sedative-hypnotics is very common, although not guideline-endorsed. The incidence among new users is not well studied, and there are currently no recommendations favoring any specific agent. We quantified the risk for chronic use in first-time hypnotic users, and the association of the initial choice of hypnotic with later usage patterns.


We used the computerized database of Israel’s largest healthcare provider. All 236,597 new users of sedative-hypnotics between the years 2000–2005 were followed for 10 years. Filled prescriptions in the second, fifth, and tenth years were recorded. The association of the first hypnotic choice (benzodiazepine/Z-drug) with chronic consumption was assessed using multivariate logistic regression.


Average age on first use was 63.7 (SD ± 16.4) years. 58.6% were women. Benzodiazepines were initiated in 154,929 (65.5%) of the cases. Benzodiazepine users were older and of lower socioeconomic status, compared to Z-drug users (p < 0.001). On the tenth year, 103,912 (66.8%) of new users claimed ≤ 30 DDDs of hypnotics, 3,1724 (20.4%) were long-term users (≥ 180 DDD/year), and 828 (0.5%) used excessively (≥ 720 DDD/year). Z-drugs were associated with an increased risk of long-term use on the second year [17.3% vs. 12.4%, RR = 1.40 (1.37–1.43)] as well as on the fifth [21.9% vs. 13.9%, RR = 1.58 (1.55–1.61)] and tenth year [25.1% vs. 17.7%, RR = 1.42 (1.39–1.45)], p < 0.0001. Similar results were also observed for daily and excessive use (p < 0.001).


One in five new users of sedative-hypnotics will become a long-term user, but only 0.5% will become excessive users. Z-drugs were associated with an increased risk of chronic use.


(MESH) Benzodiazepines Zolpidem Zopiclone Hypnotics and sedatives Drug tolerance Adult Drug dependence Risk Sleep initiation and maintenance disorders Insomnia 


Compliance with ethical standards

Ethical approval was obtained from the CHS institutional ethics review board.

Supplementary material

228_2018_2531_MOESM1_ESM.docx (82 kb)
ESM 1 (DOCX 82 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Family Medicine, Rabin Medical CenterClalit Health ServicesPetah TikvaIsrael
  2. 2.Department of Quality Measurements and Research, Chief Physician’s OfficeClalit Health ServicesTel AvivIsrael
  3. 3.Department of Family Medicine, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical CenterTel Aviv University Sackler School of MedicineTel AvivIsrael
  5. 5.Department of Public Health, Faculty of Health SciencesBen-Gurion University of the NegevBeershebaIsrael
  6. 6.Siaal Research Center for Family Medicine and Primary Care, Faculty of Health SciencesBen-Gurion University of the NegevBeershebaIsrael

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