Zolpidem, a commonly used hypnotic drug, is independently associated with an increased risk of inpatient falls, according to a study published online Nov. 19 in the Journal of Hospital Medicine.
Bhanu Prakash Kolla, MD, of the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minn., and associates conducted a retrospective cohort study involving adult non-intensive care unit inpatients at a tertiary care center to examine the risk of falling associated with use of zolpidem. Demographics and other risk factors for falls were identified from electronic medical records and the fall rate was compared for those who were prescribed and did not receive zolpidem (11,358 patients) and those who were administered zolpidem (4,962 patients).
The researchers found that the fall rate was significantly higher among those administered zolpidem (3.04% versus 0.71%). The association persisted after accounting for multiple confounders, including age, gender, insomnia, delirium status, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio, 4.37). There was no significant difference for patients taking zolpidem who experienced a fall and other hospitalized patients with respect to age and opioid, antidepressant, sedative-antidepressant, antipsychotic, benzodiazepine, or antihistamine use.
"Our study, the largest in an inpatient cohort, reveals that zolpidem administration is associated with increased risk of falling even after accounting for insomnia, delirium, and multiple other risk factors," the authors write. "Presently, because there is limited evidence to recommend other hypnotic agents as safer alternatives in inpatient settings, non-pharmacological measures to improve the sleep of hospitalized patients should be investigated as preferred methods to provide safe relief from complaints of disturbed sleep."
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