The use of short- and long-acting hypnotics in clinical medicine.
1 Activity of short- and long-acting benzodiazepines is reviewed with reference to pharmacokinetics and residual sequelae, and to efficacy and adverse effects. 2 Some benzodiazepines may not lead to obvious effects on performance, such as nordiazepam and clobazam, and the persistence of residual sequelae may not relate obviously to elimination half-lives (as with diazepam and possibly flunitrazepam). However, benzodiazepines with mean half-lives less than 8 h may have residual sequelae, whereas hypnotics with mean half-lives greater than 16 h are likely to lead to impared performance and/or anxiolytic effects the next day. 3 Potassium chlorazepate 15 mg, with its long-acting metabolite nordiazepam, would seem to be the drug of choice for insomnia secondary to anxiety. For the insomniac without significant psychopathology, temazepam 10-20 mg, triazolam 0.125-0.25 mg and for occasional use, diazepam 5-10 mg, provide the initial approach. Flurazepam hydrochloride 15-30 mg, nitrazepam 5-10 mg and flunitrazepam 1 mg and above, have persistent residual effects and should be reserved for refractory patients, and for those in whom some impairment of performance the next day would be acceptable. 4 There is little or no evidence to suggest that the proper use of the short-acting hypnotics, triazolam and temazepam, leads to a worsening of sleep on withdrawal. However, some benzodiazepines may lead to disturbances of sleep and/or rebound insomnia, and nitrazepam and flunitrazepam may be implicated.
D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003975:Diazepam / Q000378:metabolism; D005445:Flunitrazepam / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D011597:Psychomotor Performance / Q000187:drug effects; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D005445:Flunitrazepam; D003975:Diazepam