Background: Z drugs are primarily prescribed for short-term treatment of patients having trouble falling asleep. According to relevant literature, the number of people using Z drugs and the prescribed dosage have both increased after COVID. Therefore, this study was aimed to evaluate the prescribed dosage of Z drugs between pre-pandemic and post-pandemic in a regional hospital in Taiwan.
Objectives: The objective of this study is to assess the appropriateness of Z drug prescriptions in 2019 and 2024, and to compare the differences and trends between those two years.
Methods: Data of 288 psychiatric outpatients, excluding self-paid prescriptions and non-health insurance cases, was collected from a regional hospital in Taiwan. Patients in the study were prescribed Zolpidem or Zopiclone in both 2019 and 2024. The selected timeline is based on the World Health Organization(WHO) definition of COVID-19 pandemic. According to the WHO anatomical therapeutic chemical (ATC) - daily defined dose (DDD) Index, Prescribed daily dose (PDD)/DDD ratios in 2019 and 2024 of Zopiclone, Zolpidem and overall Z drugs were calculated. The primary outcome measurement is whether the PDD/DDD ratio exceeds 1 and a statistically significant difference is observed. A retrospective statistical analysis was conducted using a paired sample t-test by SPSS.
Results: Among the whole collected data of 288 Z drug prescriptions, 173 (60.07%) were for Zolpidem and 115 (39.93%) were for Zopiclone. The mean PDD/DDD ratios (± standard deviation) of Zopiclone, Zolpidem, overall Z drugs in 2019 are 1.27(±0.44), 1.41(±0.54),1.36(±0.50), respectively. In 2024, the corresponding mean PDD/DDD ratios are 1.36(±0.48), 1.45(±0.53), 1.41(±0.51), respectively. Through a sample paired t-test, the t value is -2.5528 for Zopiclone, -1.5131 for Zolpidem and -2.889 for overall Z drugs. The corresponding p values are 0.0120, 0.1321, 0.004, respectively.
Conclusions: The retrospective statistical analysis demonstrates a statistically significant increase in the overall usage of Z drugs and Zopiclone after the pandemic, whereas the dosage of Zolpidem had no statistically significant difference. The PDD/DDD of Z drugs are greater than 1, suggesting that the prescriptions may surpass recommended dosage. Given above results, the usage of Z drugs should be curtailed and restricted and only used in short-term. Enhanced healthcare education on sedative-hypnotics is imperative to alleviate the dependence caused by long-term use.
