Prescription of Benzodiazepines Continues to Decline in Germany

This year again I want to publish some comments on the development of the pharmaceutical market in Germany.  The figures for 2012 were presented recently in the Drug Prescription Report 2013 (Arzneiverordnungsreport 2013, edited by U. Schwabe and D. Paffrath, Springer-Verlag 2013).Today I report the figures for hypnotics and sedatives on the one hand, and tranquilizers on the other hand, these are mainly benzodiazepines and the so-called Z-drugs (zopiclone, zolpidem, zaleplon). The latter are used only as hypnotics.

Sedatives and Hypnotics

In 2012, the ongoing trend of declining numbers of prescriptions of benzodiazepines in Germany, which began in 1992, continued. While 34 million DDD (defined daily doses) were prescribed in 2011, this number was 28 million DDD in 2012. This is a further decrease of almost 18%. Furthermore, this represents a decline by 65% from the 81 million DDD in 2003.

Since 2009, the number of prescriptions of the Z-drugs is also decreasing – though much more slowly. 80 million DDD had been prescribed in 2011, 77 million DDD in 2012, which is a decrease of 4%. With 3 million DDD in 2012, herbal hypnotics play only a minor role in Germany since 2004.

Specifically, the prescriptions of the essential compounds were distributed as follows:

Benzodiazepines (Hypnotics-Indication), percent change compared to 2011, pricing represents average of different generics:

Lormetazepam       10.6 Mio. DDD         -12.5%          € 0.37

Temazepam             5.3 Mio. DDD         -12.2%          € 0.68

Nitrazepam              3.3 Mio. DDD         +1.1%           € 0.36

Brotizolam                2.5 Mio. DDD         -11.7%          € 0.68

Flunitrazepam           2.3 Mio. DDD         -23.3%          € 0.56

Flurazepam              1.6 Mio. DDD           -9.5%           € 0.63

Triazolam                 1.0 Mio. DDD           -8.4%           € 0.62

Z-Drugs:

Zopiclon                   45.7 Mio. DDD         -1.5%             € 0.67

Zolpidem                  28.9 Mio. DDD         -4.6%             € 0.64

Zaleplon with its extremely short half-life has practically no relevance in Germany. Chloral hydrate with 1.1 million DDD and melatonin with 1.3 million DDD have a small market share. Both compounds, however, with prices of € 1.11 and € 1.08, respectively, are more  expensive than the above drugs.

Tranquilizers

The prescription of tranquillizers, which are also primarily benzodiazepines, has also continuously declined in from Germany for many years. However, the absolute number of prescriptions is still significantly higher than that of the benzodiazepine hypnotics. In 2011, 119 million DDD were prescribed, in 2012 this number was 111 million DDD. This represents a decline by as much as nearly 7%. The particularly long-acting diazepam, unfortunately, is still the second-most prescribed benzodiazepine in Germany. Otherwise prescriptions largely represent the short to medium long-acting substances that are actually preferable in terms of their pharmacokinetics.

Benzodiazepines (Tranquilizer-Indication), percent change compared to 2011, pricing represents average of different generics:

Lorazepam                         35.9 Mio. DDD          -10.7%          € 0.84

Diazepam                          24.9 Mio. DDD           -7.2%           € 0.42

Bromazepam                     15.6 Mio. DDD           -9.9%           € 0.53

Oxazepam                         10.5 Mio. DDD           -1.1%           € 0.84

Alprazolam                           8.3 Mio. DDD           -1.3%           € 0.44

Clorazepate dipotassium      3.0 Mio. DDD           -9.9%           € 0.65

The 5-HT1A receptor agonist buspirone  with a volume of 0.9 million DDD at a price of € 1.28 practically plays no role.

Overall, these figures show that – different from what German physicians are occasionally accused of – the prescription of benzodiazepines or Z drugs is handled quite critical. If, for example, the number of prescriptions of hypnotics is compared with the prevalence of insomnia, it appears that only a minority of the affected people are treated with a benzodiazepine or a Z-drug.

 

This post is also available in: German

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