Hypnotics, dosage

Detoxiflcation may be accomplished with phenobarbital (60 mg of phe-nobarbital for 500 mg of glutethimide). If concomitant codeine dependence is present (and this codependence should be strongly suspected), then methadone can be used adjunctively (10 mg of methadone for 120 mg of codeine) (Khajawall et al. 1982). Approximate sedative-hypnotic dosage equivalencies are listed in Table 3-5. 

Compound (Trade Name) Routes of Administration Examples of Therapeutic Uses Comments Hours Usual Sedative-Hypnotic Hypnotic Dosage, mg ... 

CifiHijClNj. White plates m.p. 125 C. Diazepam is one of several benzodiazepines which are very widely used as minor tranquillizers for allaying anxiety, as hypnotics or, in sufficiently high dosage given intravenously, as pre-anaesthetic sedatives. 

D. dosages of the hypnotic may be increased each night until the desired effect is achieved... 

However, lorazepam and oxazepam are relatively safe for older adults when given in normal dosages. Buspirone (BuSpar) also is a safe choice for older adults with anxiety because it does not cause excessive sedation, and the risk of falling is not as great. Before bus-pirone therapy is begun, benzodiazepines and sedatives and hypnotics are gradually withdrawn. Buspirone, unlike most of the benzodiazepines, must be taken regularly and is not effective on an as-needed basis. 

Sporadic use (e.g., for the induction of sleep after a psychostimulant binge) does not require specific detoxification. Sustained use can be treated as described in the previous sections on detoxification from therapeutic or high dosages but with added caution. In mixed opioid and benzodiazepine abuse, the patient should be stabilized with methadone (some clinicians use other oral preparations of opioids) and a benzodiazepine. Buprenorphine should not be administered with benzodiazepines, because a pharmacodynamic interaction is possible (Ibrahim et al. 2000 Kilicarslan and Sellers 2000) and fatalities have been reported with the combination (Reynaud et al. 1998). Sedative-hypnotic withdrawal is the more medically serious procedure, and we usually... 

Tolerance to hypnotic effects develops after 2 weeks of continuous use of triazolam. Efficacy offlurazepam, quazepam, and temazepam lasts for at least 1 month of continuous nightly use. Estazolam reportedly maintains efficacy at maximum dosage (2 mg nightly) for up to 12 weeks. 

Bromural (Bromovaletone) This drug is made the same way that Carbromal is made, except that the intermediate is bromo-isovaleryl bromide. The 1 to 1 molar ratio and everything else remains unchanged. Yields colorless crystals, mp 147-149°. This is a rapid-action, short-duration hypnotic. It is well tolerated and has a low toxicity. Dosage 300-600 mg. 

Paraldehyde is a safe hypnotic, acting within 30 min and causing no undo effects on the heart. It does produce addiction, however, and should not be used frequently. Dosage 2-8 ml, as a hypnotic. 

Chlorobutol is a mild hypnotic with analgesic properties, used in seasickness, persistent hiccupping, and irritations due to chronic skin diseases. Dosage 300 to 1,200 mg, mp 77-78°. 

CNS depressants When barbiturates, narcotics, other hypnotics (or systemic anesthetics), or other CNS depressants are to be given in conjunction with magnesium, adjust their dosage with caution because of additive CNS depressant effects of magnesium. 

Use of the extended-release (XL) preparation is recommended because of increased tolerability, decreased seizure risk, and the increased ease of use associated with a once-a-day preparation. Treatment with the sustained-release (SR) or XL preparation is initiated at a dose of 150 mg, preferably taken in the morning. After 4 days, the dosage may be increased to 150 mg twice a day (SR) or 300 mg once daily in the morning (XL). Gradual dose titration helps to minimize initial anxiety and insomnia. Temporary use of anxiolytic or hypnotic agents is reasonable in some patients but generally should be limited to the first few weeks of treatment. 

With the use of major tranquillisers, for example, thioridazine, chlorpromazine, or perphenazine, it is possible to withdraw opiate dependents who are highly motivated. The dosages can be titrated to the degree of clinical symptoms and this can be monitored with key carers through an out-patient clinic. The use of hypnotics should be restricted to short-term use due to their own dependency problems, but they can be a useful addition, particularly in the early phases of the treatment programme. 

In these situations, treatment procedures in TCM that are similar in approach to the hypnotic and sedative drugs should not be used, or used only with caution. Instead, procedures that disperse constrained Qi, clear heat, promote digestion, and remove dampness and phlegm should be applied. Herbs and a diet that tonify the blood should be used for a long period of time. All of these can assist western drugs to calm the mind in an effective way and to reduce their side effects. TCM treatment can thus shorten the course of treatment required with hypnotic and sedative drugs and reduce their dosage. 

Netz, B., and Engstam, P. O. Lysergic Acid Diethylamide (LSD-25) and Suggestibility. Part 11 Effects of a Threshold Dosage of LSD-25 on Hypnotic Susceptibility. MPI B-rapport nr 17, dec 1968. Stockholm Militarpsykologiska Institutet, 1968. 

Benzodiazepines listed here are indicated specifically as hypnotic agents and are not approved for other uses [antianxiety, anticonvulsant, and so forth]. Virtually all benzodiazepines have sedative-hypnotic effects, and other benzodiazepines may be administered to produce sedation or sleep, depending on the dosage and the patient. 

Most of the minor tranquilizers in the BZD exhibit similar clinical effects they differ primarily in their duration of action and in the dosage required to achieve the same effect. The BZDs are classified as short- (triazolam [Halcion]), intermediate- (alprazolam [Xanax] and lorazepam [Ativan]), and long-acting (chlordiazepoxide [Librium] and diazepam [Valium]). Of the various BZDs available in the United States in 2002, those primarily prescribed as anxiolytics and hypnotics include the intermediate- and long-acting variety. 

Depending on dosage, barbiturates may act as either sedatives or as hypnotics. Subjectively, the effects of barbiturates are very similar to those of alcohol. Like alcohol intoxication, a barbiturate state of intoxication involves... 

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