Primary Care Prescribing Patterns for Benzodiazepines and Z-Drugs, and Evidence Gaps Concerning Hydroxyzine and Seasonality: A Systematic Review.

Abstract

Introduction: Medications with sedative and hypnotic properties, such as benzodiazepines, the so-called 'Z-drugs', and hydroxyzine, are used in primary care. However, data regarding their prescribing patterns, particularly in the context of seasonality, remain limited. Aim: This review aims to assess the current knowledge regarding primary care prescribing patterns for medications with potential sedative and hypnotic effects, with particular emphasis on benzodiazepines, 'Z-drugs', and hydroxyzine. Material and Methods: The systematic review was conducted following the PRISMA guidelines. The PubMed, Web of Science and Scopus databases were searched. Fourteen original English-language publications from 2015 to 2026, which focused on the primary care prescription of selected groups of medications with hypnotic properties, were included. Results: Most of the studies included concerned benzodiazepines, with inconsistent prescribing patterns. Some studies reported a decrease in the rate of their prescription, whilst others indicated an increase, particularly among older people and patients with multimorbidity. Data concerning 'Z-drugs' were less extensive and showed heterogeneous prescribing trends across countries and study periods. Overall, the findings indicate substantial international variability in hypnotic prescribing in primary care. Evidence regarding hydroxyzine prescribing was particularly limited, with only one study specifically examining its prescribing patterns in primary care. Data on the seasonal prescribing patterns for all groups of medications were limited. Conclusions: Prescription of medications with sedative and hypnotic properties remains an important part of primary healthcare practice. Yet, significant research gaps remain regarding hydroxyzine prescribing and the seasonal variation in hypnotic and sedative prescribing.