Study Sedative-Hypnotic Drugs

Respiratory ejects Although preliminary studies did not reveal respiratory depressant effects at hypnotic doses of zaleplon in healthy subjects, observe caution if zaleplon is prescribed to patients with compromised respiratory function because sedatives/hypnotics have the capacity to depress respiratory drive. Depression As with other sedative/hypnotic drugs, administer zaleplon with caution to patients exhibiting signs or symptoms of depression. Suicidal tendencies may be present in such patients and protective measures may be required. Intentional overdosage is more common in this group of patients therefore, prescribe the least amount of the drug that is feasible for the patient at any one time. 

Extensive sleep studies have been conducted with a variety of sedative-hypnotic drugs, and all of these drugs appear to alter the normal distribution of rapid eye movement (REM) and non-REM sleep. Most of the older sedative-hypnotic agents markedly depress REM sleep. In contrast, when the benzodiazepines are used in appropriate doses, they depress REM sleep to a much smaller extent. As with treatment of anxiety, the choice... 

Buspirone causes less psychomotor impairment than diazepam and does not affect driving skills. The drug does not potentiate the central nervous system depressant effects of conventional sedative-hypnotic drugs, ethanol, or tricyclic antidepressants, and elderly patients do not appear to be more sensitive to its actions. Tachycardia, palpitations, nervousness, gastrointestinal distress, and paresthesias may occur more frequently than with benzodiazepines. Buspirone also causes a dose-dependent pupillary constriction. Blood pressure may be elevated in patients receiving MAO inhibitors. A number of buspirone analogs have been developed (eg, ipsapirone, gepirone, tandospirone) and are under study. 

Thalidomide was formerly used as a sedative-hypnotic drug. It is used in the treatment of leprosy. Recent studies indicate that the compound may be effective against cancer. 

Comparable findings for lifetime prevalence of psychiatric disorders were obtained in another study of 133 persons, which also found that 47% received a concurrent DSM-III diagnosis of substance abuse or dependence (Khantzian and Treece 1985). The most frequently abused substances were sedative-hypnotics (23%), alcohol (14%), and cannabis (13%). Similar rates of psychiatric disorders were found in other studies of drug abusers (Mirin et al. 1986 Woody et al. 1983). Although such diagnoses do not imply causality, and, in many cases, opioid dependence causes or exacerbates psychiatric problems, some causal link seems likely (Regier et al. 1990). 

Eight healthy male subjects with a mean age of 34.1 years volunteered for this study. During their participation in the study, they resided on a clinical research unit. The subjects had extensive histories of illicit drug use that included recent ingestion (within the past 2 years) of opiates, marijuana, stimulants, alcohol, and sedative-hypnotics, although they were not dependent on any drug (except nicotine). 

Finally, long-term insomnia is not only persistent but disabling. Studies suggest that almost all of these patients have either an associated psychiatric disorder, an associated drug use, abuse, or withdrawal problem, or an associated medical disorder. As mentioned above, treatment of these associated disorders may be sufficient to treat the insomnia as well. However, if the underlying disorder is not treatable or if there is a requirement to relieve the symptom of insomnia before the underlying condition can be relieved, it may be necessary to treat the insomnia symptomatically with a sedative-hypnotic agent. 

Kava originates from the root of the Piper methysticum (kava) plant that grows predominately in the South Pacific islands. This drug has been used for centuries by various local cultures because of its sedative and antianxiety effects. Kava has likewise gained popularity in western societies, and studies suggest that kava extracts can be used as an alternative to traditional sedative-hypnotic and anxiolytic drugs, such as benzodiazepines (see Chapter 6).21,39 Kava may also produce... 

Zopiclone was the first of the new sedative-hypnotics to be launched in the late 1970s and has been shown to be equi-effective with the standard sedative-hypnotic benzodiazepines such as flurazepam and temazepam. There is evidence that zopiclone may cause less "hang-over effects than the conventional benzodiazepines but some studies have shown that this drug does produce performance decrement when this is tested shortly after treatment. A similar profile has been reported for zolpidem while abercarnil... 

Clinical studies showed that elderly patients are more sensitive to drugs such as sedatives, hypnotics, and analgesics. The most extensive studies show a decrease in responsiveness to /3-adrenoreceptors, stimulants, and blockers. Hypothermia is poorly tolerated by the elderly, as their body temperature regulation is impaired. 

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. 

Valerian is an herbal sleep remedy that has been studied for its sedative-hypnotic properties in patients with insomnia. The mechanism of action of this herb is still unknown, but it may involve inhibition of the enzyme that breaks down y-aminobutyric acid (GABA). The recommended dose for insomnia ranges from 300 to 600 mg. An equivalent dose of dried herbal valerian root is 2 to 3 grams soaked in 1 cup of hot water for 20 to 25 minutes. As with melatonin, and other herbal products not regulated by the Food and Drug Administration (FDA), valerian is not regulated for quality or consistency. 

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