Five-year trends in hypnotic drug consumption: a comparative analysis between the Republic of Serbia, Croatia, and Spain (2020-2024)

Background

Mental disorders represent a major and growing public health challenge worldwide, significantly contributing to disability, reduced quality of life, and increased healthcare utilization. Among them, depressive and anxiety disorders are the most prevalent, often presenting with comorbid sleep disturbances such as insomnia. Insomnia is not only a symptom but also an independent risk factor for the development and exacerbation of psychiatric and somatic conditions. Consequently, it frequently requires pharmacological management, particularly when non-pharmacological approaches prove insufficient or unavailable. Hypnotic medications, including benzodiazepines, non-benzodiazepine hypnotics (Z-drugs), and other sedative agents such as first-generation antihistamines, are commonly prescribed in clinical practice. However, their use is associated with concerns regarding tolerance, dependence, cognitive impairment, and other adverse effects, especially with long-term administration. The COVID-19 pandemic further influenced mental health, leading to increased psychological distress, sleep disturbances, and potential changes in prescribing patterns of hypnotic drugs. Understanding these trends is essential for promoting rational pharmacotherapy and minimizing risks associated with inappropriate use.

Objectives

:The aim of this study was to analyze the consumption of hypnotic drugs in the Republic of Serbia during the period 2020-2024 and to compare it with consumption patterns in Croatia and Spain, in order to identify potential differences and trends at both national and international levels.

Methods

Data on drug consumption in Serbia were obtained from the website of the Medicines and Medical Devices Agency of Serbia (ALIMS), while data for Croatia and Spain were collected from the websites of HALMED and AEMPS. Drug consumption was analyzed according to the Anatomical Therapeutic Chemical (ATC) classification and expressed as defined daily doses per 1000 inhabitants per day (DDD/TID). The analysis included benzodiazepine hypnotics (N05CD), Z-drugs (N05CF), and first-generation antihistamines (R06AA). Linear regression analysis was used to assess consumption trends, while differences between countries were evaluated using ANOVA.

Results

The results showed a statistically significant increase in the consumption of midazolam and zolpidem in Serbia during the observed period. Midazolam consumption was significantly higher in Serbia compared to Croatia and Spain. Nitrazepam consumption was higher in Croatia than in Serbia, although no statistically significant trend was observed in Serbia. A statistically significant increase in dimenhydrinate consumption was also observed in Serbia, while the consumption of valerian preparations showed no statistically significant trend.

Conclusions

This study revealed notable differences in hypnotic drug utilization patterns among Serbia, Croatia, and Spain. The results indicate an increasing trend in the use of certain hypnotics in Serbia, particularly Z-drugs, while benzodiazepine consumption showed variable trends. These findings emphasize the importance of implementing evidence-based guidelines, promoting non-pharmacological approaches to insomnia, and ensuring appropriate patient education. Further research is warranted to explore the underlying factors influencing these trends, including the impact of the COVID-19 pandemic, healthcare policies, and sociocultural determinants, in order to support safer and more rational pharmacotherapy.

Keywords:hypnotics; benzodiazepines; Z-drugs; insomnia; drug utilization; ATC classification.

References

No references