apsul
Undesirable Effects and Complications of Treatment with Hypnotic Drugs
at Therapeutic Doses
( modified from Estivill et al. )
Class/drug (half-
life)
Hangover
effect
Rebound
insomnia
Tolerance Dependence/abuse
Comments
Hypnotic BZDs
Short (<6h)
triazolam
0 +++
+++ ++
Can have depressant effect on respiration compared with
other BZDs
midazolam
0
+++
+++
++
brotizolam
0
+++
+++
++
Intermediate (6-24h)
loprazolam
+ / ++
++ / +++
++ / +++
++
At high doses, hangover effect greater
lormetazepam
+ / ++
++ / +++
++ / +++
++
flunitrazepam
+ / ++
++ / +++
++ / +++
++
Long (>24h)
flurazepam +++ 0
a
+ ++
Should be avoided because of increased risk of falling
and fractures
nitrazepam +++ 0
a
+ ++
quazepam +++ 0
a
+ ++
Hypnotic non-BZDs
Short
zolpidem
0 + 0
0
Tolerance and hangover effects may occur with
overdosage and/or longterm treatment
zopiclone
++ ++ +
+
Doses >7.5 mg can increase adverse events without
increased efficacy
zaleplon
b
0
may appear
after 5 wks
b
No sedative effects are observed the day after
administration and no significant psychomotor changes
have been reported 5-6h following administration of
10mg at midnight
a. With BZDs that have a long half-life, rebound insomnia is not common and appears later
b. The available data are not conclusive
BZD = benzodiazepine
0 indicates no effect; + indicates slight effects; ++ indicates moderate effects; +++ indicates severe effects
Terzano MG et al. Insomnia in General Practice. Clin.Drug Invest.2005;25(12):745-764
Estivill E,Bove A,, Garcia-Borreguero D, et al. Consensus on drug treatment, definition and diagnosis for insomnia. Clin. Drug Invest. 2003;23(6):351-85
Cermin Dunia Kedokteran No. 152, 2006
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