A survey of the effects of ramelteon on benzodiazepine-dependence: Comparison between a ramelteon add-on group and a continuous benzodiazepine administration group

In general, long-term benzodiazepine hypnotics are prescribed for patients in whom it is difficult to reduce benzodiazepine hypnotics. Unlike benzodiazepine receptor (BZ)-mediated sleep agents, ramelteon induces quasi-natural physiological sleep owing to its mechanism of action. We conducted a survey of ramelteon and BZ-dependence in patients with insomnia. Study subjects were patients with insomnia (42 cases), who were divided into a ramelteon group (22 cases; administered 8 mg/day of ramelteon before sleep in addition to BZ) and a control group (20 cases; continually administered only BZs), with a mean disease duration of 11.3 ± 9.6 years. All data were analyzed using two-way repeated measures analysis of variance. A significant improvement in scores at Week 16 over those of Week 0 was observed in the ramelteon group when a questionnaire concerning BZ-dependence and withdrawal symptoms was used. A significant improvement in scores at Week 16 from those at Week 0 was also observed in the Pittsburgh Sleep Quality Index excerpt and in the Global Assessment of Functioning in the ramelteon group. The Wilcoxon rank-sum test showed that the number of concomitantly used BZ hypnotics decreased significantly in the ramelteon group after Week 16, while no such change was observed in the control group. Thus, by adding ramelteon to therapy for patients with long-term insomnia, we were able to reduce the number of benzodiazepine hypnotics that were used concomitantly.