Sedative, Hypnotic, Anxiolytic Use Disorders Medication
- Author: Christopher L Sola, DO; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK) more...
Medication Summary
A variety of drugs are used both in the acute and the long-term setting for the treatment of sedative, hypnotic, and anxiolytic use disorders. Drug selection depends upon whether toxicity or withdrawal symptoms are being targeted.
Benzodiazepine antagonist
Class Summary
These agents are used in reversing the CNS depressant effects of benzodiazepine overdose. Its ability to reverse the benzodiazepine-induced respiratory depression is difficult to predict.
Flumazenil (Romazicon)
Benzodiazepine antagonist has a high affinity for the benzodiazepine receptor, making it a competitive antagonist. Flumazenil is short-acting, with a half-life of 0.7-1.3 h. Because most benzodiazepines have longer half-lives, multiple doses of flumazenil may be required to avoid relapse back into a sedative state.
Barbiturates
Class Summary
These agents are used in some cases to facilitate smooth withdrawals in patients with benzodiazepines and barbiturate dependence.
Phenobarbital (Barbita, Luminal, Solfoton)
Chosen for withdrawal because of long half-life and wide therapeutic index. General principle is that sedatives with longer half-lives have less severe withdrawal symptoms. Arbitrary doses are given, and treatment is individualized to respect variable effects in different patients.
Benzodiazepines
Class Summary
In dependent patients, these are used in a manner similar to phenobarbital to wean patients from short-acting benzodiazepines. The general principle is that sedatives with longer half-lives have less severe withdrawal symptoms. Various patient-specific dosing strategies are used. If symptoms are severe enough to require inpatient treatment, IV lorazepam or diazepam is used.
After stabilizing the patient, the tapering dose is calculated by dividing the total dose by 5 and reducing by this amount weekly.
Diazepam (Valium)
Depresses all levels of CNS (eg, limbic, reticular formation), possibly by increasing activity of GABA. Individualize the dosage and increase cautiously to avoid adverse effects.
Lorazepam (Ativan)
Sedative-hypnotic with short onset of effects and relatively long half-life.
By increasing the action of GABA, which is the major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.
Important to monitor patient's blood pressure after administering dose. Adjust dose as necessary.
Clonazepam (Klonopin)
Suppresses muscle contractions by facilitating neurotransmission of GABA and other inhibitory transmitters.
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