Drugs used to treat insominia
1. Benzodiazepine receptor agonists
Benzodiazepines (triazolam, temazepam, midazolam, lorazepam, estazolam). Non-benzodiazepines (imidazopyridines, e.g. zolpidem; pyrazopyrimidines, e.g. zaleplon; cyclopyrolones, e.g. zopiclone).
2. Pharmacological effects
Benzodiazepines – shorter latency to sleep, longer duration of sleep, decreased REM sleep, increased slow-wave sleep. Zopiclone – similar to benzodiazepines. Zaleplon and zolpidem – stated to have little adverse effect on sleep profile. There is evidence that the therapeutic efficacy is maintained even after several months of treatment.
3. Main side effects
Long half-life benzodiazepines cause day-time sedation. Dose-related anterograde amnesia. Impaired reaction time and vigilance. In elderly, cognitive impairment; falls causing fractures. Rebound insomnia can occur after withdrawal of short half-life drugs. Recurrence of original symptoms can occur when drug is stopped. Withdrawal effects on abrupt discontinuation of drug. These include:
dizziness, confusion and dysphoria.
Because of the frequency of side effects, benzodiazepine ligands are only recommended for the short-term (4 weeks) treatment of insomnia.
4. Other treatments include:
Sedative antidepressants (venlafaxine, trazodone, nefazodone, TCAs, mianserin, mirtazepine). Antihistamines (diphenhydramine, doxylamine). Melatonin (may shorten sleep latency but little effect on sleep time). Valerian extract (evidence of efficacy in double-blind studies). It should be noted that all these alternative treatments for insomnia also have side effects, some of which (e.g. TCAs) are potentially more serious than those occurring with the benzodiazepine group.
1. Benzodiazepine receptor agonists
Benzodiazepines (triazolam, temazepam, midazolam, lorazepam, estazolam). Non-benzodiazepines (imidazopyridines, e.g. zolpidem; pyrazopyrimidines, e.g. zaleplon; cyclopyrolones, e.g. zopiclone).
2. Pharmacological effects
Benzodiazepines – shorter latency to sleep, longer duration of sleep, decreased REM sleep, increased slow-wave sleep. Zopiclone – similar to benzodiazepines. Zaleplon and zolpidem – stated to have little adverse effect on sleep profile. There is evidence that the therapeutic efficacy is maintained even after several months of treatment.
3. Main side effects
Long half-life benzodiazepines cause day-time sedation. Dose-related anterograde amnesia. Impaired reaction time and vigilance. In elderly, cognitive impairment; falls causing fractures. Rebound insomnia can occur after withdrawal of short half-life drugs. Recurrence of original symptoms can occur when drug is stopped. Withdrawal effects on abrupt discontinuation of drug. These include:
dizziness, confusion and dysphoria.
Because of the frequency of side effects, benzodiazepine ligands are only recommended for the short-term (4 weeks) treatment of insomnia.
4. Other treatments include:
Sedative antidepressants (venlafaxine, trazodone, nefazodone, TCAs, mianserin, mirtazepine). Antihistamines (diphenhydramine, doxylamine). Melatonin (may shorten sleep latency but little effect on sleep time). Valerian extract (evidence of efficacy in double-blind studies). It should be noted that all these alternative treatments for insomnia also have side effects, some of which (e.g. TCAs) are potentially more serious than those occurring with the benzodiazepine group.
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