Sedative-hypnotic drugs adverse effects

Coadministration of ritonavir with certain nonsedating antihistamines, sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations may result in potentially serious and/or life-threatening adverse reactions due to possible effects of ritonavir on the hepatic metabolism of certain drugs (see Contraindications). 

All barbiturates (except phenobarbital) except when used to control seizures Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients. High... 

T effects OF amiodarone, astemizole, atorvastadn, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem X effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John s wort, tobacco X effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin EMS T Effects of amiodarone, diazepam, midazolam and BBs, may need X- doses concurrent use of Viagra-type drugs can lead to hypotension X- effects of warfarin concurrent EtOH use can T adverse effects T glucose ODs May cause an extension of adverse SEs symptomatic and supportive Rivasrigmine (Exelon) [Cholinesterase Inhibitor/Anri ... 

Drug(s) Alcohol Classification/ Action Sedative-hypnotic Route/Method of Administration Oral, from various beverages [wine, beer, other alcoholic drinks] Effect Desired by User Euphoria relaxed inhibitions decreased anxiety sense of escape Principal Adverse Effects Physical dependence impaired motor skills chronic degenerative changes in the brain, liver, and other organs Additional Information See Chapter 6... 

Both the neuroleptics and the sedative-hypnotics may cause severe, long-term adverse health effects, depending on the dosage and how long the drugs are in use. 

Other classes of drugs not included in Figure 22-3 that may exert sedative effects include most antipsychotic and many antidepressant drugs and certain antihistaminic agents (eg, hydroxyzine, promethazine). As discussed in other chapters, these agents differ from conventional sedative-hypnotics in both their effects and their major therapeutic uses. Since they commonly exert marked effects on the peripheral autonomic nervous system, they are sometimes referred to as "sedative-autonomic" drugs. Certain antihistaminics with sedative effects are available in over-the-counter sleep aids. Their autonomic properties and their long durations of action can result in adverse effects. 

Trimipramine is a sedating tricyclic antidepressant that has been used as a hypnotic (1) it shares this activity with other drugs of its class, notably amitriptyline, dosulepin, doxepin, and trazodone, and with the tetracyclics mianserin and mirtazapine. Trimipramine may be preferred for this purpose, since it has less effect on sleep architecture, including REM sleep (2), and has only a modest propensity to produce rebound insomnia in a subset of patients (3). Sedative antidepressants may be particularly appropriate for individuals at risk of benzodiazepine abuse and patients with chronic pain (4). The usual pattern of tricyclic adverse effects, especially antimuscarinic and hypotensive effects and weight gain, can be expected. Some authors, enthusiastic about GABA enhancers, contend that antidepressants are not useful hypnotic alternatives (5). 

The pharmaceutical industry has tried hard to convince doctors and patients that these chemicals arc revolutionary drugs that specifically reduce anxiety, making people calm and relaxed. In fact, the minor tranquilizers are just another variation on the theme of alcohol and other sedative-hypnotics, with the same tendency to produce adverse effects and dependence. 

Usually, differences in the therapeutic response or adverse events are too small to detect at an equivalent plasma level between ordinary adult and elderly patients to make this a requirement. However, separate studies are requested of sedative hypnotic psychoactive drugs or drugs having a significant CNS effect, and, similarly, if phase II and III studies are suggestive of an age-related difference. 

D Risk for Injury related to sedative or hypnotic effects ot drug Disturbed Sleep Pattern related to adverse drug effects... 

Any new hypnotic should induce and maintain natural sleep without producing residual sedative effects during the day it should not cause dependence or interact adversely with other sedatives, including alcohol. The ideal hypnotic should not cause respiratory depression or precipitate cardiovascular collapse when taken in overdose. So far no drug fulfils all these criteria. 

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