Several classes of medications are used in the treatment of insomnia. They include the benzodiazepines, non-benzodiazepine hypnotics, antidepressants, and over-the-counter medications. There are six benzodiazepines that are specifically marketed as hypnotics in the United States or in Canada: flurazepam, temazepam, triazolam, estazolam, quazepam, and (in Canada only) nitrazepam. Several other benzodiazepines (e.g., lorazepam, clonazepam, oxazepam),… Read More »
Benzodiazepine hypnotics can be categorized into three groups based on their pharmacokinetic characteristics: short-acting, intermediate-acting, and long-acting. Short-acting benzodiazepines such as triazolam (Pfizer’s Halcion, generics) generally have elimination half-lives of 6 hours or less; intermediate-acting benzodiazepines such as temazepam (Mallinckrodf s Restoril, generics), oxazepam (Wyeth’s Serax / Serepax, Boehringer-Ingelheim’s Adumbran, generics), and lormetazepam (Wyeth’s Loramet,… Read More »
Non-benzodiazepine hypnotics were introduced in most markets in the early 1990s. To date, three non-benzodiazepine hypnotics have been launched for insomnia — zolpidem, zopiclone, and zaleplon (Wyeth and King Pharmaceuticals’ Sonata). Characteristics that distinguish these drugs from traditional benzodiazepines (discussed later) are their increased receptor-binding specificity, favorable pharmacokinetics, and overall broader range of safety. More… Read More »
Drug treatment of late-life depression or schizophrenia is of great importance, as the functional psychoses are among the most common psychiatric diseases in the elderly. It therefore seems astonishing that there are great deficits in the drug research that has been done with this age group. There are almost no studies specifically on the treatment… Read More »
Rapid eye movement sleep behavior disorder is a disorder of motor control during rapid eye movement sleep characterized by complex and often violent motor behaviors usually accompanied by vivid dreams. Polysomnography reveals a complete or intermittent loss of physiological muscle atonia and an excessive electromyographic (EMG) phasic activity during rapid eye movement sleep. Etiology, Pathophysiology,… Read More »
Dopaminergic Agents in the Treatment Of Restless Legs Syndrome Levodopa was the first dopaminergic agent found effective in restless legs syndrome and has since shown evidence of efficacy in controlled trials. Benes et al. found improved quality of sleep, reduced sleep latency, and better quality of life with levodopa / benserazide given in a single… Read More »
Periodic limb movements in sleep represent a habitual motor accompaniment of restless legs syndrome, found in over 80% of the cases on polysomnography. The recent finding that genes associated with restless legs syndrome are highly associated with periodic limb movements in sleep also indicates the close, but poorly understood relationship between the two. Periodic limb… Read More »
Quetiapine Pharmacology Quetiapine is an atypical antipsychotic with a half-life of two to three hours. It has high affinity for 5-HT2A receptors and weak affinity for dopamine, muscarinic, and adrenergic receptors. Typical antipsychotic doses are 150 to 800 mg daily. Sleep Efficacy There are no randomized controlled trials in primary insomnia. Quetiapine 25 or 100… Read More »