Pharmacodynamics of temazepam in primary insomnia: assessment of the value of quantitative electroencephalography and saccadic eye movements in predicting improvement of sleep.
OBJECTIVE
Quantitative electroencephalographic parameters and saccadic eye movements are frequently used as pharmacodynamic measures of benzodiazepine effect. We investigated the relationship between these measures and the hypnotic effect.


METHODS
The correlation between the pharmacodynamic measures and sleep quality was determined in 21 patients with primary insomnia. The pharmacokinetic-pharmacodynamic relationships were characterized after administration of 20 mg oral temazepam. The hypnotic effect was determined on the basis of polysomnographic sleep recordings and a subjective sleep evaluation questionnaire. Correlations between pharmacodynamic measures and the improvement of sleep were investigated.


RESULTS
The pharmacokinetic-pharmacodynamic relationships for the parameters derived from electroencephalography and saccadic eye movements showed considerable interindividual variability. Administration of temazepam led to a significant improvement in the objective parameters sleep period efficiency, wake time after sleep onset, and sleep efficiency and in the subjective assessment of sleep quality. No significant correlations were observed between the pharmacokinetic-pharmacodynamic-derived parameters and the improvement in objective or subjective sleep parameters.


CONCLUSIONS
In subjects with primary insomnia the administration of 20 mg oral temazepam results in changes in both the pharmacodynamic measures and in quality of sleep. No individual correlations between the pharmacodynamic measures and quality of sleep were observed. We concluded that the investigated pharmacodynamic measures are of value in the first assessment of clinical efficacy and for the selection of the dose(s) to be investigated in subsequent trials that aim at showing clinical efficacy. However, the conclusive quantification of clinical efficacy should be performed only on the basis of the clinical end point itself.
Tuk
B
B
Division of Pharmacology, Leiden/Amsterdam Center for Drug Research, The Netherlands.
Oberyé
J J
JJ
Pieters
M S
MS
Schoemaker
R C
RC
Kemp
B
B
van Gerven
J
J
Danhof
M
M
Kamphuisen
H A
HA
Cohen
A F
AF
Breimer
D D
DD
Peck
C C
CC
D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D012438:Saccades / Q000187:drug effects*; D012890:Sleep / Q000187:drug effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013693:Temazepam / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D013693:Temazepam