Background & Objectives: Hypnotics have been associated with many adverse effects, such as drowsiness, confusion, falls and dizziness, especially in elderly population. Moreover, chronic use can cause decreased cognitive performance and addiction. A regional prevention campaign "Hypnotic? Not necessarily needed" conducted in the Canton of Vaud, focused on this topic. This study aims to describe introduction and discharge prescription of hypnotic drugs during stay in an internal medicine ward.
Methods: The study took place in a 70-bed internal medicine department of a Swiss regional hospital for a period of 3 months. Inclusion criteria were: age 18 or more, hospital stay for more than 24 hours, discernment and patient's approval. Demographic data (age, gender, diagnosis, co-morbidity) and medication data (chronic hypnotic use, hypnotic's introduction, day of introduction, drug-related problems, and administrative data) were collected.
Results: 290 patients were included. 73% of them were over 65 years old and 58% were women. 34% had a chronic use of hypnotics before hospital stay and 44% had a prescription for hypnotics after hospital stay. Hypnotics medication were introduced in 37% (n=108) of patients, mostly as required (68%). Half (52%) of hypnotics were prescribed during the first 24 hours of hospital stay and 76% of these introductions were not reassessed during hospital stay. Drugs introduced were: benzodiazepines (47%), clomethiazol (32%), benzodiazepine related drugs (11%; zolpidem, zopiclone) and other hypnotics (10%; herbal drugs, melatonin, antidepressant and antipsychotic). Different hypnotics were used depending on age: lorazepam for people < 65 years old, and clomethiazol for ≥ 65 years old. Drug-drug interactions were detected in 68% of new hypnotic prescription: 87% pharmacodynamic (mutual increase of adverse reactions) and 13% pharmacokinetic (impact on drug disposition). After hospital stay, 37% (n=40) of the patients had a new hypnotic drugs on their discharge prescription compared to their preadmission treatment.
Discussion & Conclusions: Introduction of an hypnotic medication happened in nearly 40% of hospitalized patients. Most of the time, physicians reassessed the new hypnotic on discharges prescriptions, one-third of hypnotics are kept at the end of the hospital stay. These prescriptions may generate chronic use and expose patients to drug-related problem (adverse effects and interactions).