Role of hypnotic drugs in general practice

Article Abstract:

Because insomnia or inability to sleep affects more than 25 percent of the adult population, general practice physicians often encounter patients with sleep disorders. Hypnotic medications are used to treat insomnia, and act to promote sleep and decrease alertness. These agents can only provide symptomatic relief and may not reverse the underlying mechanisms causing insomnia. Among hypnotic drugs, the benzodiazepines are the treatment of choice, because they are both safe and effective and have limited interaction with other drugs. Benzodiazepine hypnotics are used for the symptomatic relief of transient insomnia and as a supplemental therapy for persistent or chronic insomnia. Transient insomnia lasting several days to a few weeks may be caused by emotional problems, medical illness, or a change in the patient's sleep-wake schedule or environment. Certain drugs interfere with sleep patterns and their discontinuation improves insomnia. Treatment of transient insomnia includes hypnotic drug therapy combined with improvement of sleep habits. Chronic insomnia lasting for longer than a month may result from an underlying illness, and treatment of the illness often cures the insomnia. Hypnotics may worsen sleep-related breathing disorders, but may improve abnormal muscle movements during sleep. This article provides guidance to the general practice physician in selecting the appropriate hypnotic medication and starting dose; instructing patients; determining clinical effectiveness of the drug therapy; and recognizing conditions in which a hypnotic should not be used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Physicians, Medical professions, Internists

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Safety of estazolam: the United States clinical experience

Article Abstract:

Estazolam, a type of benzodiazepine, was developed in the United States as a hypnotic drug and is currently marketed in over 40 countries. The benzodiazepines are generally considered safe and effective, are involved in few drug interactions, and are even safe when taken in massive overdoses. However, the various different types of benzodiazepines may differ in their absorption, distribution and clearance from the body, which may affect their safety and effectiveness. For example, benzodiazepines that are not rapidly eliminated from the body may prolong sedation and decrease performance during the day, which is of particular concern in the elderly, the physically-impaired, and persons who drive automobiles. Benzodiazepines that are rapidly eliminated from the body may not maintain the normal period of sleep and may produce withdrawal symptoms. These hypnotic agents may cause adverse effects on breathing, mood, and memory, and may also have the potential for being abused. The safety of the new benzodiazepine, estazolam, was assessed in a total of 1,320 normal subjects and patients with insomnia. Estazolam had no effect on vital signs or laboratory measurements. Some adverse effects of estazolam included somnolence or prolonged drowsiness, dizziness, hypokinesia or decreased movement, and abnormal coordination, although these are expected side effects of benzodiazepine drugs. There were no consistent effects of estazolam on psychomotor performance including memory. The data suggest that estazolam is a safe and effective treatment for insomnia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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Efficacy of estazolam: the United States clinical experience

Article Abstract:

Hypnotic agents are used to treat transient insomnia, which is characterized by sleeplessness lasting several days to a few weeks, with difficulty falling asleep, frequent wakings during the night, or early morning wakings. These drugs may also be used for long-term treatment of chronic insomnia. The ideal hypnotic agent should have a rapid onset of action and be capable of maintaining sleep for the normal sleep period of eight hours. The effects of the drug must end the next morning to prevent daytime sedation, and the quality of sleep should be normal. Benzodiazepines are hypnotic agents, which may differ in their rates of absorption, distribution, and clearance from the body. Estazolam is a type of benzodiazepine that was developed in the United States as a hypnotic. Its effectiveness was evaluated in well-controlled sleep laboratory studies and outpatient clinical trials. Patients included those with transient or chronic insomnia, young adults and the elderly, and psychiatric patients with associated sleep disorders. Estazolam improved sleep latency or onset, total sleep time, number of night wakings, and depth and quality of sleep in patients with chronic insomnia. Two milligrams of estazolam works as an effective hypnotic for at least six weeks without causing tolerance, or decreased sensitivity of the patient to the drug action. The results show that estazolam is an effective treatment for situational insomnia, and it improves sleep problems in patients with insomnia related to moderate or severe anxiety and depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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