Safety and Efficacy of Chronic Hypnotic Use

NCT ID: NCT01006525

Last Updated: 2011-11-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

116 participants

Study Classification

OBSERVATIONAL

Study Start Date

2005-12-31

Study Completion Date

2011-08-31

Brief Summary

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The purpose of the study is to determine how safe and effective it is for people with insomnia to use zolpidem on a nightly basis for one year.

Detailed Description

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The acknowledged drugs of choice for the pharmacological treatment of insomnia are the benzodiazepine receptor agonist hypnotics (BzRA). Studies show that at therapeutic doses, used over the short-term, the abuse liability of BzRAs is relatively low and their efficacy outweighs their minimal risks. However, an increasing number of patients use BzRAs nightly for longer periods of time than is currently indicated (i.e. 4 weeks) and, minimal data on the long-term abuse liability and efficacy of these drugs exist.

This project, using both prospective and retrospective methods, will address questions about the long-term abuse liability and efficacy of the BzRAs. The questions being raised are: What are the abuse liability and efficacy of hypnotics currently being used chronically and what is the prospective abuse liability and efficacy of hypnotics used chronically? Zolpidem is the chosen standard for this project as it is the most frequently prescribed BzRA and also arguably the BzRA with the best short-term efficacy and safety profile. The focus of the first question is clinical; it is about the long-term abuse liability and efficacy of BzRAs, specifically zolpidem, as it is currently being prescribed and about the type of patients who receive this drug. The second question addresses the issue of whether a standard BzRA can be prescribed efficaciously and safely for the long-term to patients with primary insomnia.

Conditions

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Primary Insomnia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Insomniacs

Primary insomniacs, ages 21-70, in good general health.

zolpidem

Intervention Type DRUG

placebo or zolpidem (10mg)daily for one year

Interventions

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zolpidem

placebo or zolpidem (10mg)daily for one year

Intervention Type DRUG

Other Intervention Names

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zolpidem (Ambien)

Eligibility Criteria

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Inclusion Criteria

1. age 21-70 yrs
2. non-pregnant females who agree to standard birth control for 12 months and males
3. two of the following chronic insomnia complaints: \>30 min sleep latency, \< 6 hrs sleep, or nonrestorative sleep.
4. meet DSM-IV criteria for primary insomnia

Exclusion Criteria

1. any acute or unstable illness: conditions making it unsafe for the subject to participate, conditions with a potential to disturb sleep (i.e. acute pain, respiratory infection), and conditions which could interact with the pharmacokinetics or pharmacodynamics of zolpidem.
2. chronic illnesses: renal failure, liver disease, seizures, and dementing illnesses.
3. current psychiatric diseases: alcohol or substance abuse, depression, and schizophrenia.
4. a history of alcohol or substance abuse within the past two years.
5. a prestudy positive urine drug screen
6. consuming \>14 standard (1oz) alcoholic drinks per week
7. caffeine consumption \>300 mg/day
8. smoking during the night (11pm-7am).
9. medications including: anxiolytics, hypnotics. both prescription and OTC, (except in the chronic zolpidem group), antidepressants, anticonvulsants, sedating H1 antihistamines (non-sedating second generation H1 antihistamines are allowed), systemic steroids, respiratory stimulants and decongestants, prescription and OTC stimulants, prescription and OTC diet aids, herbal preparations, and narcotic analgesics. All medications and doses will be documented.
10. sleep disordered breathing (SDB) defined as \>10 apnea-hypopneas events per hour of sleep time or any other primary sleep (e.g., restless legs syndrome) or circadian disorder.
Minimum Eligible Age

21 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Henry Ford Health System

OTHER

Sponsor Role lead

Responsible Party

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Henry Ford Health System

Principal Investigators

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Timothy A. Roehrs, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Henry Ford Health System

Surilla Randall, Ph.D.

Role: STUDY_DIRECTOR

Henry Ford Health System

Locations

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Henry Ford Sleep and Research Center

Detroit, Michigan, United States

Site Status

Countries

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United States

References

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Roehrs TA, Randall S, Harris E, Maan R, Roth T. Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms: a prospective placebo-controlled study. J Psychopharmacol. 2012 Aug;26(8):1088-95. doi: 10.1177/0269881111424455. Epub 2011 Oct 16.

Reference Type RESULT
PMID: 22004689 (View on PubMed)

Roehrs TA, Randall S, Harris E, Maan R, Roth T. Twelve months of nightly zolpidem does not lead to dose escalation: a prospective placebo-controlled study. Sleep. 2011 Feb 1;34(2):207-12. doi: 10.1093/sleep/34.2.207.

Reference Type RESULT
PMID: 21286241 (View on PubMed)

Roehrs T, Roth T. Hyperarousal in insomnia: pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Med. 2019 Sep;61:52-56. doi: 10.1016/j.sleep.2019.04.010. Epub 2019 Apr 25.

Reference Type DERIVED
PMID: 31255482 (View on PubMed)

Roehrs TA, Roth T. Hyperarousal in insomnia and hypnotic dose escalation. Sleep Med. 2016 Jul;23:16-20. doi: 10.1016/j.sleep.2016.06.008. Epub 2016 Jul 6.

Reference Type DERIVED
PMID: 27692272 (View on PubMed)

Roehrs TA, Roth T. Gender Differences in the Efficacy and Safety of Chronic Nightly Zolpidem. J Clin Sleep Med. 2016 Mar;12(3):319-25. doi: 10.5664/jcsm.5574.

Reference Type DERIVED
PMID: 26446253 (View on PubMed)

Randall S, Roehrs TA, Roth T. Efficacy of eight months of nightly zolpidem: a prospective placebo-controlled study. Sleep. 2012 Nov 1;35(11):1551-7. doi: 10.5665/sleep.2208.

Reference Type DERIVED
PMID: 23115404 (View on PubMed)

Other Identifiers

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R01DA017355

Identifier Type: NIH

Identifier Source: org_study_id

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