Z-Drugs: Non-Benzodiazepine Hypnotics
Introduction to Z-Drugs
- Z-drugs are a class of non-benzodiazepine hypnotic medications that include zopiclone, zaleplon, and zolpidem, which were developed in the 1990s primarily for the treatment of insomnia, as reported by The Lancet Psychiatry 1, 2
- The American Academy of Sleep Medicine indicates that zopiclone, zaleplon, and zolpidem are the three main Z-drugs, named for the first letter of their chemical names and their classification as hypnotics 1, 2, 3
Clinical Use and Safety Concerns
- The American Academy of Sleep Medicine recommends Z-drugs for the short-term treatment of insomnia, as they reduce sleep latency and improve sleep quality, though they may not significantly increase total sleep duration 3
- The Lancet Psychiatry reports that dispensed prescriptions of Z-drugs increased from 5.4 million to 6.5 million between 2008 and 2014, before falling to 6.0 million by 2018, in England 1, 4
- The Annals of Internal Medicine warns about cognitive and behavioral changes that may be serious or life-threatening associated with Z-drugs, particularly impaired driving ability and psychomotor impairment 5, 6
Dependence, Tolerance, and Withdrawal
- The Lancet Psychiatry notes that approximately half of patients prescribed Z-drugs in England had been treated continuously for at least 12 months, despite recommendations against long-term use, and that sudden cessation can lead to physical and psychological withdrawal symptoms 1
- The Lancet Psychiatry recommends that patients treated long-term should be offered careful tapering and support if discontinuation is planned 1, 2