1 / 20

Addressing Hypnotic medicines use in primary care

Addressing Hypnotic medicines use in primary care . National Prescribing Service . Presented by Joyce McSwan Accredited Consultant Pharmacist. Insomnia in Primary Care. 95%. 80%. What Insomnia is not. 3 Ds of Insomnia . D ifficulty falling asleep D ifficulty staying asleep OR

marius
Download Presentation

Addressing Hypnotic medicines use in primary care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Addressing Hypnotic medicines use in primary care National Prescribing Service Presented by Joyce McSwan Accredited Consultant Pharmacist

  2. Insomnia in Primary Care 95% 80%

  3. What Insomnia is not....

  4. 3 Ds of Insomnia • Difficulty falling asleep • Difficulty staying asleep OR • Day time distress (associated with non refreshing sleep)

  5. 1. Identify and manage contributing factors first Medications Behavioural Substance Use Insomnia Complaint Circadian rhythm disorder Psychiatric Disorder Situational Environmental Primary sleep disorder Medical condition

  6. 1a. Offer non-drug therapies for insomnia • Benefits: • Persistent sleep improvements after therapy • Reduced potential for harms • No risk of drug dependence

  7. Most evidence - Behavioural and cognitive therapies • In 4-8 weeks, • Fall asleep faster (23 mins vs 14 mins earlier) • Reduce their time awake (30 mins after sleep onset) • Improvement up to 2 years • > 55 yo • Hypnotic medicines do not provide this long-term benefit

  8. 2. Hypnotic Medicines

  9. AVOID Diazepam Flunitrazepam Nitrazepam

  10. 2a.Best practice

  11. 2b. Hypnotics in the Elderly • Meta analysis – • NNT 13>60 yo for 1 month to improve sleep • NNT 6causing adverse effect - fatigue, cognitive impairment, serious events following falls, fractures and MVA

  12. 3. Stepped care approach to stopping hypnotic medicines • Simple strategies may start the ball rolling. • Lack of evidence for adjunctive therapy in place of hypnotics. • 1/3 have trouble stopping • Gradual dose reduction may still be required after short-term use • Minimise Rebound insomnia

  13. Tapering dose gradually on an individual basis (8-12 weeks) • Time in between dose reductions (several days) • Reduce by 10-20% / week • Change to equivalent diazepam then reduce dose • Reduce one benzodiazpine at a time.

  14. One size does not fit all.... • Hypnotic medicines may be acceptable for: • Chronic use: • No adverse effects • Sleeping well • Aware about unintentional dependence • Attempts have been made to stop but refused or unsuccessful • Combination with non-drug therapy might reduce hypnotic dose • Review regularly

  15. Other NPS resources: • NPS News 67, 2010 – Addressing hypnotic medicines use in primary care • NPS Prescribing Practice Review 49: Management options for improving sleep • Clinical audit: Use of benzodiazepines, zolpidem and zopiclone in insomnia • For Patients : Reduction plan for your sleeping tablets • Case study 62: Maximising sleep and minimising potential harms

  16. Good Night and Sweet dreams

More Related