No Association of Benzodiazepines, Z Drugs and Other Anxiolytics with Dementia
Benzodiazepines, so-called Z-drugs (such as zolpidem, zopiclone, and zaleplon), and other anxiolytics are commonly prescribed drugs that have some cognitive side effects. For this reason, there has been concern that the drugs may increase risk of dementia, and small studies had suggested that this might be the case. However, a new large study found no subsequent dementia risk after taking these drugs.
In a 2020 article in the American Journal of Psychiatry, researchers Merete Osler and Martin Balslev Jørgensen described a cohort and nested case-control study of 235,465 adult patients in Denmark in which they found no association of benzodiazepines, Z-drugs, or other anxiolytics with a subsequent diagnosis of dementia. Participants were patients over the age of 20 who were hospitalized for an affective disorder. Of these, 75.9% had been prescribed one of the drugs in question, and 4.2% went on to be diagnosed with dementia.
While participants in this study who had the lowest use of benzodiazepines or Z drugs showed a minimal increased risk of dementia compared to those who took none of these drugs, those who had the highest use of benzodiazepines and Z drugs actually had the lowest incidence of dementia in the study.
The previous studies may have been “confounded by indication” meaning they did not take the underlying psychiatric condition for which the drugs were prescribed into account.
Ambien Linked to Emergency Room Visits, Among Other Risks
Zolpidem, better known by one of its trade names, Ambien, is widely prescribed for the short-term treatment of insomnia. It can sometimes cause adverse reactions, particularly among women and the elderly. The Substance Abuse and Mental Health Services Administration (SAMHSA) has reported that over a recent 5-year period, emergency department visits for adverse reactions to zolpidem increased by almost 220%.
Peter Delaney, Director of SAMSHA’s Center for Behavioral Health Statistics and Quality, suggested that doctors should consider alternative strategies for treating insomnia, including improving sleep hygiene by avoiding caffeine, exercising regularly, and sleeping in a quiet, dark room. He also suggested that doctors should be aware of what other medications a patient is taking, and ideally all of a patient’s prescriptions should be collected from the same pharmacy, so the pharmacist can act as a second pair of eyes identifying possible drug interactions.
Women and men metabolize zolpidem differently, and according to Sam Fleishman of the American Academy of Sleep Medicine, many women can still be impaired by the drug 8 hours after taking it. In 2013, after reports of adverse reactions to zolpidem increased, the Federal Drug Administration (FDA) required manufacturers of drugs containing zolpidem to reduce the recommended dose for women by half, from 10 mg to 5 mg, or 12.5 mg to 6.25 mg for the extended-release version. The FDA also suggested halving the dosage prescribed to the elderly, and reducing the recommended dose for men.
Some of the adverse reactions to drugs containing zolpidem include daytime drowsiness, dizziness, hallucinations, sleepwalking, and even “sleep driving.” When combined with antianxiety medications, narcotic pain relievers, or alcohol, zolpidem’s sedative effects can be enhanced to dangerous levels.
