This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bain, K. T. Articles by Gallagher, R. Search for Related Content PubMed PubMed Citation Articles by Bain, K. T. Articles by Gallagher, R. Social Bookmarking                   What's this?

Toward evidence-based prescribing at end of life: A comparative review of temazepam and zolpidem for the treatment of insomnia

ExcelleRx, Inc., Philadelphia, Pennsylvania

Douglas J. Weschules, PharmD

ExcelleRx, Inc., Philadelphia, Pennsylvania

Calvin H. Knowlton, RPh, MDiv, PhD

ExcelleRx, Inc., Philadelphia, Pennsylvania

Rollin Gallagher, MD, MPH

ExcelleRx, Inc., Philadelphia, Pennsylvania, Drexel University College of Medicine, Philadelphia, Pennsylvania

A comparative review of temazepam and zolpidem use in managing insomnia in the hospice patient was undertaken to determine whether treatment with temazepam is a more cost-effective approach for this patient population.

A MEDLINE search was conducted to identify pertinent literature, including clinical trials and reviews that involved temazepam or zolpidem. Published data was used as background information and provided in the discussion.

This retrospective analysis, conducted from June 2002 through November 2002, focused on the prescribing patterns of temazepam and zolpidem in our hospice practice setting. We examined the reasons for discontinuation of each agent, along with the frequency of therapeutic change from temazepam to zolpidem. The top 10 ICD-9 codes associated with each treatment modality were investigated to determine any prescribing patterns.

A total of 4,752 participants were prescribed either temazepam or zolpidem during this six-month period. Of the 4,065 patients prescribed temazepam 9.9 percent had the agent discontinued, whereas, 13.0 percent of those taking zolpidem (n = 687) terminated therapy. Reasons for discontinuation included change in dose, incomplete efficacy, change in patient status, adverse drug reaction, cultural/social issues and "other." Analyses of prescribing patterns and the reasons for termination of each drug therapy were completed and compared with results found in the primary literature.

Due to the limited financial resources available for hospice care, our goal is to provide the most clinically appropriate and cost-effective agents for hospice patients. With the lack of data pertaining to the hospice patient, physicians often are faced with challenges in deciding the most appropriate therapy. They may prefer one agent over another based on current medical opinion rather than sound clinical evidence. After review of the primary literature and the prescribing patterns in our setting, there is currently no evidence in our patient population to support that zolpidem is superior to benzodiazepines for the treatment of insomnia.

Key Words: temazepam • zolpidem • sedatives • insomnia • sleep disorders • palliative care

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?