title: [Pharmacotherapeutical approaches to insomnia patients with cardiac diseases and after heart transplantation].
abstract: Insomnia in patients with heart transplantation and cardiac disease is a common problem. Organic factors, immunodepressant medication (e.g. ciclosporine and steroids) and psychological factors may account for this symptom. The article reviews different hypnotic drugs and their value in the treatment of insomnia. For short-time treatment, medication with benzodiazepine hypnotics may be useful. If the problems of drug dependence and rebound insomnia are taken into consideration, treatment with non-benzodiazepine hypnotics offers more safety and comfort. If insomnia is part of a depressive syndrome, pharmacotherapeutical intervention with antidepressive sedative medication is required. With regard to cardiac disease, treatment with mirtazapine, nefazodone or trazodone should be preferred because of the chinidine-like effect of tricyclic antidepressants (TCA). Sedative neuroleptic medication (e.g. melperone) is commonly given to geriatric patients; nevertheless, patients with chronic insomnia may also benefit from this medication. The risks and benefits of hypnotic drugs are discussed especially in relation to pharmacological interaction (cytochrome system) and cardiac disease.
authors.affiliation: Nervenklinik und Poliklinik Psychiatrie und Psychotherapie Universitätskliniken des Saarlandes 66421 Homburg/Saar, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wobrock
authors.forename: B
authors.initials: B
authors.lastname: Schwaab
authors.forename: M
authors.initials: M
authors.lastname: Böhm
authors.forename: H J
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: K
authors.initials: K
authors.lastname: Wanke
authors.forename: T
authors.initials: T
authors.lastname: Supprian
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy; D003866:Depressive Disorder / Q000188:drug therapy; D004347:Drug Interactions; D006331:Heart Diseases / Q000150:complications* / Q000188:drug therapy; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D016027:Heart Transplantation; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006633:Histamine Antagonists; D006993:Hypnotics and Sedatives; D028321:Plant Preparations