Perceptions of German GPs on benefits and risks of benzodiazepines and Z-drugs

Swiss Med Wkly. 2013 Jan 17;143:w13745. doi: 10.4414/smw.2013.13745. eCollection 2013.


Questions under study: In many countries newer non-benzodiazepines, zolpidem and zopiclone ("Z-drugs"), are prescribed instead of benzodiazepine hypnotics. This is not supported by current evidence and guidelines. The aim of this study was to compare the perceptions of GPs on the benefits and harms of benzodiazepines and Z-drugs.

Methods: A questionnaire was mailed to a random sample of 1,350 German GPs between May and June 2012. GPs were asked to rate their perceptions on a five-point Likert scale for 12 items asked for both benzodiazepines and Z-drugs. Wilcoxon signed rank test for paired observations was used for comparison between groups. Due to multiple testing, only p values ≤0.01 were considered statistically significant.

Results: A total of 458 questionnaires were returned (response 33.9%). The mean age of participants was 53.3 years (59.4% males). GPs perceived that Z-drugs were significantly more effective in terms of reduced night-time waking, feelings of being rested on waking and improved daytime functioning than benzodiazepines (p <0.0001 for all comparisons), but not in terms of reduced time to get to sleep and increased total sleep time. All studied side effects were believed to be less often for patients receiving Z-drugs (p <0.0001 for all comparisons). A total of 73.4% and 80.4% answered that tolerance or withdrawal effects on stopping occur often or very often/always for benzodiazepines, whereas these values were only 30.6% and 28.7% for Z-drugs.

Conclusions: German GPs perceived that Z-drugs were more effective and safer compared to benzodiazepines, which is not supported by current evidence. The results are quite comparable to a British survey conducted seven years before.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Azabicyclo Compounds / therapeutic use
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use*
  • Female
  • General Practitioners / psychology
  • General Practitioners / statistics & numerical data*
  • Germany
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Middle Aged
  • Piperazines / therapeutic use
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pyridines / therapeutic use
  • Risk Assessment
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Zolpidem


  • Azabicyclo Compounds
  • Hypnotics and Sedatives
  • Piperazines
  • Pyridines
  • zopiclone
  • Benzodiazepines
  • Zolpidem