Drugs can have two types of names: their general (generic) names and the trade name given by the drug company (starting with a capital letter). The same drug can have several different trade names. When a drug is listed as a controlled drug, it means that the rules for storing it, and writing and dispensing prescriptions are stricter than for other drugs.
Benzodiazepines
These have been available since the 1960s, and are the most commonly used sleeping pills. They include:
• nitrazepam (trade names Mogadon, Remnos, Somnite)
• flunitrazepam (Rohypnol)
• flurazepam (Dalmane)
• loprazolam (previously available under the trade name Dormonoct)
• lormetazepam
• temazepam.
Although all of these are prescription-only medicines, none of them is available on the NHS under its trade name, but only under its generic (-azepam) name.
Flunitrazepam and temazepam are particularly subject to abuse as street drugs, and are therefore controlled drugs. Temazepam used to be available in the form of gel-filled capsules, which were abused by users who melted the gel and injected it. This practice caused blocked blood vessels, leading to gangrene and amputations, in some cases. For this reason, the drug in this form is no longer available on the NHS. Temazepam is still available as tablets and as an oral liquid.
Nitrazepam, flunitrazepam and flurazepam are all relatively long-acting and may give a hangover effect the next day. Loprazolam, lormetazepam, and temazepam are all short-acting and produce little or no hangover. However, they are more likely to produce withdrawal symptoms. Benzodiazepines that are normally used for anxiety, such as diazepam (Valium), may also be used as sleeping pills (see Mind’s booklet Making sense of minor tranquillisers, listed under Further reading, on p. 22.)
The benzodiazepines all have similar side effects. The most common effects are: drowsiness and light-headedness the next day, confusion and unsteadiness (especially in elderly people), forgetfulness, dependence and problems with withdrawal, increase in aggression, and muscle weakness.
Occasional side effects include: headache, vertigo, changes in saliva production, low blood-pressure, stomach upsets, rashes, visual disturbances, joint pain, tremor, changes in libido (interest in sex), incontinence (loss of bladder control), difficulty urinating, blood disorders, and jaundice.
They should be used with caution in: people who have respiratory disease (such as bronchitis or asthma), muscle weakness, a history of drug or alcohol abuse, and marked personality disorder (a psychiatric diagnosis). The dose should be reduced in elderly people and others whose metabolism is slow (because the drugs stay in the system longer) and in those with porphyria (a rare, inherited illness).
Zolpidem, zopiclone and zaleplon
Zolpidem tartrate (trade name Stilnoct), zopiclone (Zimovane) and Zeleplon (Sonata) have been introduced more recently than the benzodiazepines. Although they are different from them, they act on the same brain receptors (the area of the brain where the drug has its main chemical effect). They are short acting and have little or no hangover effect.
Because problems of dependence and withdrawal occur with these drugs, as well as with the benzodiazepines, guidelines for all of them say that they should be given at the lowest effective dose, for the shortest possible time, and they should be withdrawn gradually. For zolpidem and zopiclone, a course of treatment should not last longer than four weeks, including the tapering off. For zaleplon, the manufacturer recommends that treatment should be as short as possible, and a maximum of two weeks.
Zaleplon (Sonata) appears to have less hangover effect than other sleeping pills, but is also less effective in keeping people asleep. It’s another option for people who have difficulty falling asleep, but will be less helpful for people who wake frequently. A study of zaleplon in older people showed that they got to sleep more quickly and stayed asleep for longer after zaleplon than after a placebo (dummy pill), and there seemed to be no significant hangover effects next day.
No comments:
Post a Comment