Sedative effect medications

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

Sertindole is one of the newer antipsychotic medications available. It is classified chemically as a phenylindole derivative and has activity at dopamine and serotonin receptors. It is not associated with sedative effects. Sertindole was voluntarily withdrawn from the market late 1998 due to concerns over the risk of cardiac arrhythmia s. The European Commission recommended lifting the marketing restrictions on sertindole in 2005 with a regulatory requirement of ECG monitoring. 

There appears to be little difference between benzodiazepines and kava extract in anxiolytic activity. However, kava extracts seem to have fewer side effects. Two studies with more than 3000 patients each found unwanted events in about 2% of patients during treatment with kava extract. The more frequently reported side effects were gastrointestinal complaints, allergic skin reactions, headache, and photosensitivity (Pittler and Ernst, 2000). There have been isolated reports of hepatotoxicity and acute liver failure (Escher et ah, 2001). Kava may potentiate the sedative effects of other medications including barbiturates and benzodiazepines. Kava can also cause behavioral disinhibition in a minority of individuals, including children. The most common problem, which is usually associated with persistent and excessive usage, is a scaly skin rash called kava dermopathy, which is reversible. 

Other new antidepressants, including bupropion, ven-lafaxine, nefazodone, and mirtazapine, have been found to be efficacious in the treatment of depressed adults, but only a few open-label studies have been carried out in children and adolescents (e.g., Daviss et ah, 2001). Bupropion and velanfaxine may be useful in treating youth with MDD and ADHD (Plizka, 2000 Daviss et ah, 2001). Because of the sedative effects of mirtazapine and trazodone, these medications have been used as adjunctive treatments for patients with severe insomnia. 

Psychostimulant medication can be useful in the treatment of severe, acute pain, such as that seen during a sickle cell crisis (Yaster et al., 2000). Dextroamphetamine and methylphenidate are also effective as adjuvants, as they have independent analgesic effects, and potentiate the effects of opioid analgesics. The increase in alertness afforded by the use of psychostimulants can also allow the use of larger doses of opioids (Yaster et al., 2000). Methylphenidate and dextroamphetamine have been used to diminish the sedative effects of opioid analgesic medication (Yee and Berde, 1991) in adolescent patients with malignancies or sickle crisis, and may also potentiate the effects of analgesics. Doses used by Yee and Berde (1991) were 2.5 to 10 mg bid of methylphenidate, or 2.5 to 5 mg bid of dextroamphetamine. 

Most sedative drugs, including narcotics and alcohol, potentiate the sedative effects of benzodiazepines. In addition, medications that inhibit hepatic cytochrome P450 (CYP) 3A3/4 increase blood levels and hence side effects of clonazepam, alprazolam, midazolam, and triazolam. Lorazepam, oxazepam, and temazepam are not dependent on hepatic enzymes for metabolism. Therefore, they are not affected by hepatic disease or the inhibition of hepatic enzymes. 

One week later Carl told us that he had managed to completely avoid crack use, which was supported by urine sampling. His mother said that he had appeared drowsy on the diazepam, a medication which he had not had before, while Carl reported a generally helpful calming effect He had also taken the fluoxetine, and there was a suggestion of a reduction in depression. After another week the situation was similar, although with the sedative effects... 

Aside from the bromides, phenobarbital is the oldest of the currently available antiseizure drugs. Although it has long been considered one of the safest of the antiseizure agents, the use of other medications with lesser sedative effects has been urged. Many consider the barbiturates the drugs of choice for seizures only in infants. 

Not everyone reacts to antihistamine-containing sleep aids the same way. Some people, particularly those of Asian descent, are less sensitive to the sedative effects of these medications. Others can have reactions that are opposite to the intended effect of inducing sleepiness—some people feel nervous, jittery, anxious, restless, or agitated after taking antihistamines. This is particularly true in elderly persons and young children. Others can experience a morning hangover effect, characterized by sleepiness, headache, dry mouth, constipation, and blurred vision. 

By producing sedation, many drugs will also decrease the level of anxiety in a patient. Of course, these anxiolytic properties often cause a decrease in the level of alertness in the individual. However, certain agents are available that can reduce anxiety without an overt sedative effect. Those medications that selectively produce antianxiety effects are discussed later in this chapter. 

Adverse effects. Use of diazepam as an antispasticity agent is limited by the sedative effects of this medication that is, patients with spasticity who do not want a decrease in mental alertness will not tolerate diazepam therapy very well. Extended use of the drug can cause tolerance and physical dependence, and use of diazepam for the long-term treatment of spasticity should be avoided whenever possible.102... 

Nonbenzodiazepine anxiolytic. Busprione (Bu-Spar) is the first in a class of drugs that specifically work as anxiolytics. In addition to exerting no sedative effect, this medication poses few of the disadvantages associated with the benzodiazepines—such as physical or psychological dependency—and does not significantly interact with most other compounds. 

The elimination half-lives of a number of commonly used hypnotics are shown in Table 10.1. It should be noted that many of the drugs in current use have active metabolites which considerably prolong the duration of their pharmacological effect. This is particularly true for the elderly patient in whom the half-life of the hypnotic is prolonged due to decreased metabolism and renal clearance such individuals are also more sensitive to the sedative effects of any psychotropic medication. 

Medication Relative Sedative Effect Relative Antidiolinergic Effect... 

Citrus peel oils may also be used for their antioxidative, antitumor, and radicalscavenging activities. The radical-scavenging ability of citrus peel oil may help prevent free radical-induced and various chronic diseases (48, 55, 56). Monoterpenes from volatile components and polymethoxylated flavones from nonvolatile residues have been reported to be effective inhibitors of tumor cell growth, implicating that citrus peel oils may be good cancer preventive food additives (57-59). Furthermore, citrus peel oils are useful to alleviate pain from burnt skin (60). Demonstrating anxiolytic and sedative effect, they could also be used in primary medical care against insomnia, anxiety, and epilepsy (61). 

For example, it is not uncommon when working in a mental health inpatient unit to see medication administered to reduce or eliminate violent or self-destructive behavior. The medication s sedative effect will calm one person immediately and may produce sleep another client of similar age, weight, and height may remain extremely combative. In order to achieve the same result, the second client may require a subsequent dose. Why does this happen There are no definitive or easy explanations for variability in client responses to medications. In many cases the combination of the client s unique biological system coupled with the variability of medications confirms that the use and application of medication is not an exact science. 

Bromides Certain medications with a strong sedative effect. 

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