Safety - Hypnotics and Anxiolytics

The problems associated with hypnotics and anxiolytics are well known. Benzodiazepines and z-drugs should be avoided in the elderly as they are at greater risk of becoming ataxic and confused, leading to falls and injury.

Physical and psychological dependence can occur; in addition to tolerance, and this may lead to difficulty in withdrawing the drug after it has been taken by the patient regularly for more than a few weeks.

Whilst there is a place for the use of hypnotics and anxiolytics in the short term, the aim of the indicator is to reduce inappropriate prescribing.

  Hypnotics and Anxiolytics

  • There is a high level of hypnotic and anxiolytic prescribing in NHS Wales, compared with England.
  • The problems associated with benzodiazepines (e.g. tolerance, dependence, withdrawal causing rebound insomnia) are well known, and the number of deaths associated with benzodiazepines has increased.
  • Hypnotics and anxiolytics are known to significantly increase the risk of falls.

Trend in hypnotic and anxiolytic prescribing 

Although the trend graph demonstrates that the volume of hypnotics and anxiolytics prescribed in Wales has declined over recent years, there is considerable variation in prescribing rates between health boards, and between GP practices.

Graph 3 Trend in HA prescribing

 Trend graph key

In general, prescribing of hypnotic and anxiolytics in Wales remains high in comparison to England, with five out of the seven health boards within the highest prescribing quartile when compared with CCGs in England.

Hypnotic and anxiolytic ADQs per 1,000 STAR-PUs – Quarter ending September 2019

Graph 4 HA Wales England

Key for graph

 

AWMSG has developed a resource pack containing a wealth of materials for patients and prescribers to support the review and reduction of hypnotics and anxiolytics.

The pack includes guidelines for reduction and withdrawal, reduction protocols and assessment tools, in addition to patient information leaflets and guides. 

How can changes be made?

  • Consider hypnotics only after non-drug therapies have been explored.
  • When prescribing hypnotics, use the lowest dose possible, for the shortest duration possible and in strict accordance with their licensed indications; no more than four weeks.
  • Do not offer benzodiazepines for the treatment of generalised anxiety disorder (GAD), except as a short-term measure during crises.
  • Always consider reducing hypnotics and anxiolytics where appropriate.
  • Carry out the hypnotic and anxiolytic audit from the AWMSG Educational Pack: Materials to Support Appropriate Prescribing of Hypnotics and Anxiolytics across Wales.
  • Use the hypnotic and anxiolytic reduction/withdrawal resources in the AWMSG Educational Pack.

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