Impacts of Prolonged Use of Zolpidem in the Elderly Population: a Systematic Review

Keywords

Elderly - elderly 80 years and over - Zolpidem

Introduction: Sleep disorders are prevalent in the elderly population and are often treated with non-benzodiazepine hypnotics, such as zolpidem. However, prolonged use of these drugs can lead to serious adverse effects such as cognitive impairment, mental confusion, falls, fractures and automobile accidents, which can aggravate the vulnerability of this population.

Objective: Map adverse events related to long-term use of zolpidem in the elderly population.

Methods: This is a systematic review. The eligibility criteria were cohort studies involving the elderly population, with an emphasis on use above the recommended dose of zolpidem specifically for insomnia and associated adverse events such as falls, drowsiness, dizziness and motor vehicle accidents. Articles focusing on outcomes associated with other chronic diseases were excluded. The search was carried out in five electronic databases: Medline, LILACS, Cochrane Library, Embase and PsycNET and only studies with full text available in Portuguese, English and Spanish were considered. The descriptors were “Elderly”, “Elderly 80 years and over” and “Zolpidem” and the Boolean operators “AND” and “OR” were used. The Rayyan platform was used for selection by two reviewers in an independent and masked manner. The methodological quality of the selected studies was assessed using the JBI Critical Appraisal Checklist for Cohort Studies.

Results: The sample consisted of 10 studies. The articles have a high percentage in 2014 and 2016 and were published in a variety of renowned journals. The events analyzed show that six studies described the risk of fracture associated with zolpidem, especially hip fracture. In addition, the use of the non-benzodiazepine sedative hypnotic was found to be related to the occurrence of car accidents due to cognitive alterations. The selected studies were considered to be of high to moderate quality.

Conclusion: Prolonged use of zolpidem by older people may be associated with an increase in serious adverse events, such as fractures and falls. It is therefore crucial that healthcare professionals thoroughly assess the benefits and risks before starting or continuing zolpidem therapy, considering non-pharmacological alternatives and management strategies that minimize the associated risks, as well as ensuring ongoing monitoring of these patients.

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Publikationsverlauf

Artikel online veröffentlicht:
16. September 2025