Nonbenzodiazepines-nonbarbiturates
Nonbenzodiazepines-nonbarbiturates
Nonbenzodiazepine-nonbarbiturates act as hypnotics for treatment of simple insomnia. These drugs, which offer no special advantages over other sedatives, include:
- chloral hydrate
- eszopiclone
- ramelton
- zaleplon
- zolpidem.
Diminishing returns
Chloral hydrate and zaleplon lose their effectiveness by the end of the second week. Zolpidem is usually effective for up to 35 days. Eszopiclone and ramelton are approved for long-term treatment of insomnia.
Pharmacokinetics
Nonbenzodiazepines-nonbarbiturates are absorbed rapidly from the GI tract, metabolized in the liver, and excreted in urine.
Safe and soundWarning about sleep agents
The U.S. Food and Drug Administration requires that all sedative-hypnotic drugs include a warning on the drug label about the risk of complex sleep-related behaviors. Complex sleep-related behaviors include preparing and eating food, making phone calls, and even driving when not fully awake, while having no memory of the event.
Pharmacodynamics
The mechanism of action for nonbenzodiazepines-nonbarbiturates isn’t fully known; however, they produce depressant effects similar to barbiturates.
Pharmacotherapeutics
Nonbenzodiazepines-nonbarbiturates are typically used for:
- treatment of simple insomnia
- sedation before surgery
- sedation before EEG studies.
Drug interactions
When nonbenzodiazepines-nonbarbiturates are used with other CNS depressants, additive CNS depression occurs, resulting in drowsiness, respiratory depression, stupor, coma, or death.
Warning!Adverse reactions to nonbenzodiazepines-nonbarbiturates
The most common dose-related adverse reactions involving nonbenzodiazepines-nonbarbiturates include:
- nausea and vomiting
- gastric irritation
- hangover effects (possibly leading to respiratory depression or even respiratory failure).
A chlorus of interactions
Chloral hydrate may increase the risk of bleeding in patients taking oral anticoagulants. Use with I.V. furosemide may produce sweating, flushing, variable blood pressure, and uneasiness.
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