Saturday, November 19, 2005
Meta-analysis of sedatives for insomnia in the elderly
BMJ has just published a metaanalysis evaluating the risks-benefits of sedatives for treating insomnia in the elderly. Sedatives here means benzodiazepines and benzo receptor agonists (zolpidem/Ambien, zaleplon/Sonata, etc). It aggregates data from 24 (total n=2400) randomized trials of sedative agents in people >60 years old. Most of the studies were for 2 weeks or less, although a couple were longer. They found that the number-needed-to-treat for any measurable sleep "improvement" (which was measured heterogeneously across the studies) was 13, & the number-needed-to-harm was 6 (this number catches any measurable side effect...from benign--GI upset--to severe--falls, etc). The average increase in sleep length was 25 minutes vs. placebo. The head-to-head studies of benzo's vs benzodiazepine receptor agonists essentially found no difference in effectiveness or adverse effects, including cognitive ones. Morning or daytime fatigue was significantly worse with active treatment vs. placebo, with quite a strong odds ratio (3.8, 1.88 to 7.8, p<.001). They did not mention that they were able to compare benzos to non-benzos specifically for this outcome.
All of this has me asking why do I prescribe these drugs at all and why do patients like them so much? What's the point if you feel worse the next day? This is naive of course, and insomnia is an unpleasant symptom that may have nothing to do with actual sleep/daytime energy/etc. for many patients, and these agents are effective (somewhat) for this symptom. What disappoints me is how relatively high the NNT is: 13 is great when you're saving lives through cardiovascular drugs but not to treat an unpleasant symptom. In addition, the NNH is not helpful in deciding, for a given patient, if the benefits outweigh the risks. GI upset or headache are qualitatively different from falls/severe psychomotor side effects and aggregating a global NNH is clinically meaningless.
And, I must add that in the middle of the article sits this sentence:
A significant improvement in sleep quality improved significantly[.] It actually makes sense in context but there must be a better way to say this...
5 Responses to “Meta-analysis of sedatives for insomnia in the elderly”
November 20, 2005
At the recent Missouri Hospice and Palliative Care Association Conf, two pharmacists from Hospice Pharmacia presented some data comparing temzepam (Restoril) to zolpidem (Ambien). Although their data is not strong they showed no effectiveness for switching to zolpidem if temazepam was ineffective. People did not get any improvement if they had already 'failed' temazepam.
I do not think this is published data yet, but they are frequently using this as a reason to say no to zolpidem and using temazepam first in an algorthim. I give them credit for starting to look at these subjects, but I would like to see more published data.
November 20, 2005
I almost forgot. Ambien is one of my favorite examples of clever drug marketing.
One of my day-dreaming activites when I have some spare time is to think of the many reasons behind drug brand names.
So for Ambien....
I am bien (I am good)
A.M. Bien (Morning good, or rather good morning)
If you look at the logo you can see the Am is bolded and the 'B' in AmBien is capitalized.
Clever, clever....There are more but I will save that for another day.
November 20, 2005
Also:
Abilify
Palladone
Elavil
Monistat
Focusyn (Ok, that was from a Simspons episode)...but
Focalin is a real one (dexmethylphenidate)
Lofibra (not very creative)
Levitra is quite suggestive
Many have "nice" or suggestive memes
SaraFEM
ZoLOFT
WELLbutrin
I've said before in this blog that I find the suggestive names for psychotropics, especially Abilify, creepy and Orwellian.
My favorite trade name of all time, however, for its straightforward implication of its user's unfortunate reality, is "Plan B."
November 20, 2005
Yes, I agree Abillify as a drug name kind of creeps me out too. I am glad I was not the only one.
Xanax:
a palindrome, the same forwards and backwards, thus I equate it to looking in a mirror.
Celexa:
Say it fast and it starts to sound like "Select us!"
Versed:
Can be extrabolated into "VERy SEDated"
and my favorite after Ambien......[drum roll, please]
Geodon:
"Geo-" = earth
"-don" = down
therefore "Down to earth." Great name for an anti-psychotic.
March 27, 2011
Also:
Abilify
Palladone
Elavil
Monistat
Focusyn (Ok, that was from a Simspons episode)...but
Focalin is a real one (dexmethylphenidate)
Lofibra (not very creative)
Levitra is quite suggestive
Many have "nice" or suggestive memes
SaraFEM
ZoLOFT
WELLbutrin
I've said before in this blog that I find the suggestive names for psychotropics, especially Abilify, creepy and Orwellian.
My favorite trade name of all time, however, for its straightforward implication of its user's unfortunate reality, is "Plan B."
Post a Comment