insomnia quick

insomnia quick

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Issue date: April 2004
Review date: April 2007 National Institute for
Clinical Excellence
Quick reference guide
Zaleplon, zolpidem and zopiclone
for the short-term management of insomnia
1 Guidance 2 Implementation
1.1 When, after due consideration of the use of 2.1 Implications for the NHS
non-pharmacological measures, hypnotic drug
therapy is considered appropriate for the 2.1.1 It is likely that this guidance will result in the
management of severe insomnia interfering preferential prescription of hypnotics with
with normal daily life, it is recommended that lower acquisition costs and possibly lead to a
hypnotics should be prescribed for short reduction in the prescribing of hypnotics,
periods of time only, in strict accordance with both overall and more specifically for long-
their licensed indications. term use. It is therefore expected that there
will be some savings in terms of costs directly
1.2 It is recommended that, because of the lack of associated with the prescription of hypnotics.
compelling evidence to distinguish between In 2002, a total of 3.9 million prescriptions
zaleplon, zolpidem, zopiclone or the shorter- were written for zaleplon, zolpidem and
acting benzodiazepine hypnotics, the drug zopiclone with a net ingredient cost of
with the lowest purchase cost (taking into £15.9 million. However, the overall effect and
account daily required dose and product price the timescale of this effect on NHS resources
per dose) should be prescribed. will depend on any reduction in overall
hypnotic prescribing, the proportion of
1.3 It is recommended that switching from one of prescriptions relating to the short-term
these hypnotics to another should only occur if management, the proportion of patients
a patient experiences adverse effects prescribed more expensive hypnotics as a
considered to be directly related to a specific result of adverse effects directly related to
agent. These are the only circumstances in the cheaper alternatives and the uptake of
which the drugs with the higher acquisition any non-pharmacological alternatives.
costs are recommended.
1.4 Patients who have not responded to one of
2.2 Local implementation and audit
these hypnotic drugs should not be prescribed
2.2.1 NHS organisations and clinicians who
any of the others.
prescribe treatment for people with insomnia
should review their current practice and
policies and the current patterns of
prescribing hypnotic drugs, as reported in
high-level performance indicators, to take
account of the guidance set out in Section 1.
2.2.2 Local guidelines, protocols or care pathways
that refer to the care of people with
insomnia should incorporate the guidance in
Section 1.
Technology Appraisal Guidance 77
This guidance is written in the following context:
This guidance represents the view of the Institute, which was arrived at after careful consideration of the available
evidence. Health professionals are expected to take it fully into account when exercising their clinical judgement. This
guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions
in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

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To measure compliance locally with the zolpidem or zopiclone, is prescribed, the
guidance, the following criteria could be drug with the lowest purchase cost is
used. chosen.
· Hypnotic drug therapy is used for the · A patient is switched from one of these
management of severe insomnia hypnotic drugs to another only if he or she
interfering with normal daily life only experiences adverse effects considered to
after due consideration of the use of non- be directly related to a specific agent.
pharmacological measures.…read more


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