Hypnotics, hypersensitivity

The most common unwanted effects of the barbiturates are oversedation and psychomotot impaitment, which may petsist well into the next day following a hypnotic dose. Patadoxical excitement, hypersensitivity reactions, and muscle or joint pain may occur in rare cases. Drug-drug interactions occur with the CNS sedatives, and a number of drugs have enhanced metabolism when co-administered with barbiturates (Barnhill et al. 1989). 

Hypnotics. Common hypnotics are thiopental, propofol, midazolam, etomidate, ketamine and inhaled anesthetics. The incidence of hypersensitivity reactions with thiopental is rare. Recently, thiopental was involved in less than 1% of allergic reactions in France [9]. Ever since Cremophor EL, used as a solvent for some non-barbiturate hypnotics, has been avoided, many previously reported hypersensitivity reactions have disappeared. In the last French surveys, reactions to propofol accounted for less than 2.5% of allergic reactions, and reactions to midazolam, etomidate or ketamine appear to be really rare [9]. Finally, no immune-mediated immediate hypersensitivity reaction involving isoflurane, desflurane or sevoflurane has been reported despite their wide use. 

Contraindications Metabolic/respiratory alkalosis, current treatment with sedative-hypnotics, succinic semialdehyde dehydrogenase deficiency, hypersensitivity to sodium oxybate or any component of fhe formulaf ion... 

Contraindications Acute alcohol intoxication concurrent use of centrally acting analgesics, hypnotics, opioids, or psychotropic drugs hypersensitivity to opioids... 

Tramadol ER should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opioids. Tramadol ER is contraindicated in any situation where opioids are contraindicated, including acute intoxication with any of the following alcohol, hypnotics, narcotics, centrally acting analgesics, opioids, or psychotropic drugs. Tramadol ER should not be used in patients with creatinine clearance less than 30 mL/min, or severe hepatic impairment (diild-Pugh Class C). 

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