Zolpidem and risk of falls
Zolpidem (Ambien) increases the risk of falls in inpatients, according to a new study from the Mayo Clinic. The records of hospitalized patients who were not in the intensive care unit were reviewed in this retrospective cohort study. The rate of falls was compared in those who were administered zolpidem vs those for whom it was prescribed but not administered. After controlling for age, gender, insomnia, delirium, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of stay, visual impairment, gait abnormality, dementia/cognitive impairment, and concomitantly administered meds, the rate of falls was four times higher in those administered zolpidem (n = 4962) vs those who were prescribed but did not receive zolpidem (adjusted odds ratio 4.37, 95% confidence interval [CI], 3.34-5.76; P < 0.001). The authors conclude that zolpidem was a strong, independent, and potentially modifiable risk factor for inpatient falls. The authors suggest that changing order sets so that zolpidem use is not encouraged could potentially reduce fall rates in hospitalized patients. They also suggest that there is limited evidence to recommend other hypnotic agents as safer alternatives (J Hosp Med published online Nov. 19, 2012. doi: 10.1002/jhm.1985).