Non‑benzodiazepenes (‘Z‑drugs’)

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Non‑benzodiazepenes (‘Z‑drugs’)

Non‑benzodiazepenes (‘Z‑drugs’)

An alternative pharmacotherapy class that may be considered as a temporary adjunct to CBTi in patients with severe symptoms of insomnia is non‑benzodiazepenes or ‘Z‑drugs’ (of which zolpidem and zopiclone are licensed in the UK).8,14

Duration of use8,15,16

Z-drugs are licensed for the short-term treatment of insomnia and are recommended for temporary use only – preferably less than 1 week and not more than 4 weeks (including tapering off period). Therefore, these may not be appropriate for providing a sustained solution for cases of persistent insomnia like Steve.

Dependence/ tolerance6,17

Tolerance, dependence and withdrawal syndrome may develop. As such, caution should be used when prescribing, with the lowest effective dose being prescribed for the shortest period possible (no longer than 2 weeks and preferably less than 1 week).

Renal impairment16,17

Z-drugs should be used with caution in patients with renal impairment; a lower dose may be appropriate.

Older patients17

Hypnotic drugs, including Z-drugs, can increase the risk of falls (especially in the elderly), and ataxia and confusion. They are not recommended in the elderly due to the increased risk of adverse events; if essential, a low dose should be used.

Sleep apnoea15-17

Zolpidem is contraindicated for obstructive sleep apnoea; zopiclone is contraindicated in patients with severe sleep apnoea syndrome.

Due to the chronic nature of Steve’s insomnia, as well as his age and comorbidities (CKD and sleep apnoea), his clinician decides against prescribing a short‑course of a Z‑drug and considers QUVIVIQ™.

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Considerations for the use of QUVIVIQ™ in older adults

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ACE: angiotensin-converting enzyme; CBTi: cognitive behavioural therapy for insomnia; CKD: chronic kidney disease; CPAP: continuous positive airway pressure; OTC: over‑the‑counter; SGLT2i: sodium glucose cotransporter‑2 inhibitor; TIA: transient ischaemic attack

QUVIVIQ™ is indicated for the treatment of adult patients with insomnia characterised by symptoms present for at least 3 months and considerable impact on daytime functioning.18

This information is intended for UK healthcare professionals.

▼This medicine is subject to additional monitoring.

Adverse events must be reported. Healthcare professionals are asked to report any suspected adverse reactions via www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in Google Play or Apple App Store. Adverse events should also be reported to ds.safety.uk@idorsia.com

References

  1. Sleep Foundation. Aging and sleep, 19 September 2023. Available at: sleepfoundation.org. Accessed August 2025
  2. National Institutes of Health (NIH): National Institute on Aging. A good night’s sleep. Available at: nia.nih.gov. Accessed August 2025
  3. Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med 2018;14(6):1017-1024
  4. Cohen Z L, Eigenberger P M et al. Insomnia and other sleep disorders in older adults. Psychiatr Clin North Am 2022;45(4):717-734
  5. Duffy J F, Scheuermaier K, Loughlin K R. Age-related sleep disruption and reduction in the circadian rhythm of urine output: contribution to nocturia? Curr Aging Sci 2016;9(1):34-43
  6. Riemann D, Espie C A et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023;32(6):e14035
  7. Wilson S, Anderson K et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. J Psychopharmacol 2019;33(8):923-947
  8. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Scenario: managing long-term insomnia (more than 3 months duration), May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  9. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Stroke and TIA. Scenario: secondary prevention following stroke and TIA, October 2023. Available at: cks.nice.org.uk. Accessed August 2025
  10. Morin C M, Belleville G et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601-608
  11. Solikhah F K, Nursalam N, Ulfiana E. The effect of sleep hygiene on the sleep quality in elderly. Proceedings of the 8th International Nursing Conference on Education, Practice and Research Development in Nursing (INC 2017) 2017;doi: 10.2991/inc-17.2017.26
  12. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Obstructive sleep apnoea syndrome. Scenario: management of sleep apnoea, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  13. Prolonged-release melatonin Summary of Product Characteristics
  14. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Scenario: managing short-term insomnia (less than 3 months duration), May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  15. Zolpidem Summary of Product Characteristics
  16. Zopiclone Summary of Product Characteristics
  17. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Prescribing information: Z-drugs, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  18. QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics

© NICE 2023 Daridorexant for treating long-term insomnia. Available from www.nice.org.uk/guidance/ta922. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/ publication.

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UK-DA-00657 | Date of preparation: September 2025

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