Insomnia Neurological effects

Neurological Effects. Epidemiological data show that workers exposed to tetryl during the manufacture of explosives in the workplace occasionally developed irritability, headaches, fatigue, and insomnia (Bergman 1952 Cripps 1917 Hardy and Maloof 1950). These effects suggest that... 

With chronic toxicity, nausea, anorexia, headache, vomiting, and metallic taste in the mouth may occur. Chronic use has been associated with extremity numbness and parenthesis. Other neurological effects including insomnia, dizziness, and vertigo have been reported. White blood count suppression has been seen but is generally reversible. 

Case studies have associated exposure to mercury vapor with neurological effects (e.g., tremors, insomnia, shyness, emotional instability, decreased motor function and muscle reflexes, headaches, and abnormal EEGs) (Davis et al. 1974 Jaffe et al. 1983 McFarland and Reigel 1978). Some studies have examined the relationship between nerve function and mercury levels in blood, urine, and tissue. Tissue levels of mercury have also been found to correlate with impaired nerve function. Among 23 dentists with mercury levels greater than 20 g/g (measured in wrist tissue), 30% exhibited reduced nerve conduction velocity when compared with dentists with tissue levels of mercury below 20 g/g (Shapiro et al. 1982). The decrease in nerve conduction velocity was observed in both sensory and motor nerves. 

Neurological effects asthenia 5-10%, confusion <5%, dizziness 6%, headache 10%, insomnia 5-10%, lightheadedness, myoclonus, parasthesia 5-10%, somnolence >10%, CNS excitation, and Meniere s disease. Seizures may be associated with high doses. Use with extreme caution in patients with increased ICP as a further increase may occur. 

The most serious side effects of efavirenz are psychiatric symptoms, rash and nervous symptoms. The psychiatric symptoms include suicide thoughts, depression, paranoia, manic disorders and aggressive behavior the rashes include macu-lopapular skin eruptions and life-threatening Stevens-Johnson syndrome has also been reported. The neurological symptoms are difficulty in concentration, insomnia, dizziness, confusion, agitation, hallucinations and amnesia. Additional side effect may include an increase in cholesterol and hepatic transaminase levels. 

Sateia and Nowell [85] have proposed that long-term treatment with hypnotic medication could be implemented in patients with persistent insomnia not related to mental disorders, neurological diseases, medical conditions, or the effect of a substance of abuse or medication. In addition, nonpharmacological approaches have to be proven ineffective. Circumstances in which the long-term administration of hypnotic drugs must be discontinued include the development of tolerance and dose escalation, the occurrence of severe adverse events, and the diagnosis of newly developed disabilities. 

Adverse effects Amantadine s side effects are mainly associated with the CNS. Minor neurologic symptoms include insomnia, dizziness, and ataxia. More serious side effects have been reported (for example, hallucinations, seizures). The drug should be employed cautiously in patients with psychiatric problems, cerebral atherosclerosis, renal impairment, or epilepsy. Rimantadine causes fewer CNS reactions since it does not efficiently cross the blood-brain barrier. Amantadine and rimantadine should be used with caution in pregnant and nursing mothers, because they have been found to be embryotoxic and teratogenic in rats. 

Efavirenz is a non-nucleoside reverse transcriptase inhibitor with excellent inhibitory activity against HTV-l. Its most frequent adverse effects involve the central nervous system and the skin (1). At the start of therapy, dizziness, insomnia, or fatigue is observed in most patients, and headache and even psychotic reactions have also been observed. A maculopapular rash is seen in about 10%. These adverse effects usually vanish within the first 2-4 weeks of therapy (2). About 1-2% of individuals stop taking efavirenz because of neurological or dermatological adverse events. Administration of efavirenz at bedtime reduces the incidence of severe adverse effects, and the rash can be managed by short-term antihistamines or topical corticosteroids (1). Nausea and vomiting are less often observed than in patients treated with zidovudine, lamivudine, or indinavir. 

When neurological symptoms occur in patients taking tacrolimus they are very similar to those seen in patients taking ciclosporin, with more frequent insomnia, tremor, and headaches, but a similar rate of severe neurological adverse effects, such as acute psychosis, peripheral neuropathy, seizures, encephalopathy, coma, and paralysis. Persistent speech disorders (dysarthria, apraxia, expressive aphasia, akinetic mutism), and visual blurring can also occur (SEDA-21, 391) (SEDA-22, 420) (24). 

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