gms | German Medical Science

Background: Benzodiazepines (BZD) are extensively applied for treatment of a multitude of psychic aberrations including conditions of agitation or a variety of sleep disorders. Regarding latter indication, BZD are more and more replaced by Z-hypnotics. Due to the clinical importance of these substances and lack of sufficient data we analyzed prescription characteristics of all BZD on hand including tetrazepam and that of Z-hypnotics in a German federal state during the years 2006-2012 with a focus on the year 2012.

Materials and Methods: Based on data comprising numbers of prescriptions reimbursed by statutory health insurance in the period from January 2006 until December 2012 we analyzed prescriptions of all BZD and Z-hypnotics available in Germany. In addition, tetrazepam that is utilized exclusively for cure of muscle distension was included to evaluate the pharmacoeconomic significance of this BZD with regard to withdrawal from the EU market in 2013 and to a potential abuse as a substitute for other BZD. Furthermore, patterns of prescriptions in 2012 relating to age, duration and administrative districts were examined. Because of a comparably small rate of prescriptions and the specific indications, short acting BZD like midazolam or triazolam as well as the anticonvulsant clonazepam and clomethiazole mainly used for acute alcohol withdrawal were excluded.

Results: The tranquilizers alprazolam, chlordiazepoxide, clobazam, clorazepate, medazepam and prazepam and the hypnotics brotizolam, flunitrazepam, flurazepam and zaleplon did not represent important dues of prescribed substances as reflected by numbers below 5.000 prescriptions / year. Numbers of prescriptions regarding the tranquilizers bromazepam (47.300 [2006] / 28.800 [2012], -61%), diazepam (67.800 / 43.800, -65%) and oxazepam (57.600 / 32.300, -56%) indicated that these BZD still are popular but prescription numbers declined continuously through the years. The tranquilizer Lorazepam was prescribed most frequently with an increasing number of prescriptions (65.000 / 72.000, +11%). Like tranquilizers, prescriptions of BZD applied as hypnotics also were declining during the analyzed period: lormetazepam (34.842 / 20.400, -59%), nitrazepam (21.400 / 10.900, -51%), temazepam (28.300 / 15.500, -55%). In case of the Z-hypnotics, zolpidem tended towards decreasing numbers of prescriptions (60.500 / 55.700, -9%) whereas zopiclone turned out to be favoured more and more by practitioners (69.600 / 82.800, +12%). Besides tranquilizers and hypnotics, tetrazepam was prescribed extensively with an increasing number of prescriptions (71.500 / 82.800, +12%) thus representing the most frequently used BZD. Despite the existence of a multitude of pertinent recommendations in 2012 the vast majority of BZD and Z-hypnotics turned out to be prescribed to patients between 70 and 75 years old. The indication was not of relevance since both hypnotics (mainly short acting substances) and tranquilizers (mid-long and long acting BZD) were prescribed likewise to this group. Notably, tetrazepam was found to be prescribed particularly to people with an age of 45 to 50 years. The percentage of patients receiving prescriptions of BZD permanently over a period of two or more quarters in 2012 averaged out 19%. In addition, distinct differences in the numbers of prescribed BZD and Z-hypnotics amongst the various areas became evident. For example, in the fourth largest city of the examined federal state the portion of all inhabitants to that BZD had been prescribed accounted for 28%. In contrast, in a more rural area this portion was as low as 11%.

Conclusion: This analysis revealed clearly an overuse of BZD and Z-hypnotics that has to be questioned especially with respect to the fact that the majority of this substances is prescribed to the elderly population. Hence, there is still a need to develop programs to improve the quality of benzodiazepine utilization.