Sedatives adverse effects

In two studies of short duration (18 patients each) there were benefits of using low doses of clozapine plus fluvoxamine, and the authors suggested taking advantage of this interaction (40). Patients taking fluvoxamine required relatively low doses of clozapine and had clinically significant reductions in the symptoms of their illness while avoiding the sedative adverse effects associated with the usual doses of clozapine. 

Three cases of radial nerve palsy were reported in demented elderly patients confined to wheelchairs who were treated with haloperidol. The combination of extrapyra-midal and sedative adverse effects, added to wheelchair confinement, may have resulted in pressure on the upper arm with subsequent neuropathy (18). 

There is a paucity of data examining the use of these agents in patients with hepatic impairment. Although there is no information available to recommend any necessary dosage adjustments in hepatic impairment, their use should be avoided in moderate to severe liver disease, owing to their sedative adverse effects. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

The oldest anti-anxiety agent is undoubtedly alcohol and it is certain that this drug is still routinely self-administered for this purpose. Towards the end of the eighteenth century, bromide salts were used to relieve conditions akin to anxiety despite the risk of a characteristic toxic delirium, known as bromism . Alternative treatments, such as paraldehyde and chloral hydrate, were also widely used but these too had adverse effects the former can cause psychosis but the latter is still used as a sedative and anaesthetic agent. 

The important adverse effects of the various antidepressants are often a function of their underlying pharmacologic profiles7,8 (Table 35-3). TCAs cause problematic sedative, anticholinergic, and cardiovascular adverse effects owing to their interaction with dirty receptors. While these adverse effects generally are considered to be common and bothersome, they can be quite serious in certain cases. For example, constipation in its... 

The SSRIs produce fewer sedative, anticholinergic, and cardiovascular adverse effects than the TCAs and are less likely to cause weight gain than the TCAs. The primary adverse effects include nausea, vomiting, diarrhea, headache, insomnia, fatigue, and sexual dysfunction. A few patients have anxiety symptoms early in treatment. 

However, adverse effects also include dependence and thus drug abuse. Tolerance develops within 3 months for anxiety. However considerable interindividual variability exists for the development of this tolerance. Benzodiazepines have very little effect on respiration which is not seen with sedative doses. In cases involving benzodiazepine intoxication, respiratory assistance has only been needed in patients who had also taken another CNS depressants. 

There is no cross-tolerance of buspirone with benzodiazepines or other sedative medications. Withdrawal symptoms, occurring for example after stopping benzodiazepine use are influenced by buspirone only to a minor extend. Adverse effects include dizziness, light-headiness, agitation, headache, tinnitus and nausea but those reactions are generally mild. 

Enzyme inducers will enhance the metabolism of ethosuximide and reduce its efficacy while its depressant action will be enhanced by other sedatives. Frequently occurring adverse effects include sedation and gastrointestinal disturbances such as nausea and vomiting. Rarely blood dyscrasias including agranulocytosis and pancytopenia are seen as well as serious skin reactions including Stevens-Johnson syndrome. 

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... 

Mirtazapine has been found to have synergistic depressant effects on motor and cognitive performance when used in conjunction with benzodiazepines or alcohol (Kuitunen, 1994). Somnolence and increased appetite accompanied by weight gain are common adverse effects. Lower doses are clearly associated with more sedative effects than those with higher doses. It is unclear if a similar pattern is noted for appetite and weight gain. 

Anxiolytics and Sedative-Hypnotics. Because of their large therapeutic index, measurement of anxiolytic or sedative-hypnotic serum concentrations is not usually necessary in clinical practice, unless abuse, overdose, or inadvertent toxicity are suspected. Some data indicate that plasma alprazolam levels of 40 ng/mL may be required to manage panic disorder ( 51) (see the sections Adverse Effects of Anxiolytics and Adverse Effects of Sedative-Hypnotics in Chapter 12). 

Benzodiazepines (BZDs) have been used for the treatment of depression because their sedative effects can reduce insomnia, agitation, and anxiety symptoms that frequently accompany depressed states. Considerable evidence also indicates that major depression may accompany panic and agoraphobic disorders ( 199, 200 and 201). When depression precedes the onset of panic disorder, clinical experience suggests a better response to antidepressants than to BZDs, although no studies have directly addressed this issue (202). Conversely, available evidence indicates that when depression occurs after the onset of panic disorder, treatment with either a BZD or a tricyclic may result in concomitant improvement of both the panic and depressive symptoms (198, 199, 200, 201,202 and 203). Depression, however, has been reported to be an adverse effect of BZD treatment. 

This herb has been part of folk medicine since pre-Christian times (247). It has been primarily used as a sedative and for the treatment of epilepsy. Consistent with this use, this herb reportedly can increase synaptic concentrations of GABA (248). GABA has also been isolated from Valeria and extracts of Valeria have been reported to bind to GABA receptors in rat brain. Although Valeria has been reported to be active in rodent models of depression, there have been no efficacy trials in humans. The potential adverse effects of Valeria include the sensation of strangeness ( 247) and several cases of liver damage (e.g., central lobular necrosis) (249). Mutagenicity in bacteria has been reported and attributed to unstable, water-insoluble valepotriates ( 238). As a result of these reports, many, but not all, commercial preparations of Valeria use water-soluble extracts standardized for their content of valeric acid. 

The absence of adverse effects of the BZD type and its lack of abuse potential are major advantages. The lack of sedative properties may be very important, because many dislike this feeling and find it interferes with various activities, such as problem solving, driving, and overall work function.%... 

Sedative antidepressants, such as amitriptyline, doxepin, or trazodone, in low doses, have hypnotic efficacy and may be less likely to evoke the adverse effects associated with higher doses. 

Adverse Effects Sedation, ataxia, and fatigue are the most common adverse effects reported with acute use of alprazolam in PD (39). Although tolerance to the sedative effect may develop within a few days of treatment initiation, this adaptation may be only partial. At weeks 4 and 8 in the Cross-National Collaborative study, many patients still showed signs of sedation (48% and 39%, respectively), ataxia (25% and 16%, respectively), and fatigue (19% and 16%, respectively) ( 23). 

Adolescent boys may be more vulnerable to acute dystonia than adults. Although these adverse effects can be treated with anticholinergic agents, dose reduction should also be considered. For acute dystonia, diphenhydramine (25 to 50 mg) may be given orally or intramuscularly, as can equivalent doses of benztropine (1 to 2 mg/day). Diphenhydramine has both sedative and anticholinergic properties, with the former being helpful in calming the patient whereas the latter reverses the reaction itself. 

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