P. Rayon et al., HYPNOTIC DRUG-USE IN SPAIN - A CROSS-SECTIONAL STUDY BASED ON A NETWORK OF COMMUNITY PHARMACIES, The Annals of pharmacotherapy, 30(10), 1996, pp. 1092-1100
OBJECTIVE: TO investigate how hypnotic drugs are used in Spain, specif
ically, (1) to characterize the user population in some simple demogra
phic (e.g., sex, age) and clinical (e.g., type of insomnia, type of ph
ysician who prescribed the drug) variables; (2) to estimate the propor
tion of long-term users (>3 mo); (3) to determine the frequency of dif
ferent administration schedules; (4) to determine whether the kind of
hypnotic drug prescribed according to the duration of its effect corre
lates with the type of sleep disorder or patient age, and (5) to compa
re the dosage used by the elderly with that used by adults. DESIGN: Cr
oss-sectional pharmacy-based study. SETTING: A network of 318 communit
y pharmacies throughout Spain. SUBJECTS: Patients (n = 5324) requestin
g a hypnotic drug for insomnia who agreed to take part in the study. M
AIN OUTCOME MEASURES: Distribution of the use of hypnotic drugs by age
, sex, type of insomnia, type of physician, specific hypnotic drug, da
ily dosage, treatment schedule, and duration of treatment. RESULTS: Wo
men (67%) and the elderly (58%) constituted the largest subgroups in t
he sample. Difficulties in sleep onset and in sleep maintenance as sin
gle disorders were reported by 38% and 37% of users, respectively. Pre
scriptions were written by general practitioners in 80% of cases. Dail
y use was reported by 88% and long-term use (>3 mo) by 72% of the user
s. Long-term treatment was two- to threefold more frequent in the elde
rly than in middle-aged subjects. Intermediate-action hypnotic drugs w
ere used by 59% of subjects, short-action drugs by 24%, and long-actio
n drugs by 17%. The type of hypnotic drug prescribed was not related t
o the kind of sleep disorder or the age of patients. Specialists presc
ribed long-action hypnotic drugs more often than did general practitio
ners. No relevant differences were observed between dosages used by th
e elderly and those used by adults. In both groups the dosage taken by
most patients, regardless of the drug, corresponded to the available
strength. Substitution drugs for triazolam belonged to the intermediat
e-action class in 53% of the cases. CONCLUSIONS: Recommendations on hy
pnotic drug use are largely not followed in Spain. Most patients are t
aking hypnotic drugs daily, over long time periods, and without an ade
quate dosage titration according to age. Measures should be taken to c
orrect this situation.