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Chapter: Modern Pharmacology with Clinical Applications: Sedative-hypnotic and Anxiolytic Drugs

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Sedatives and Anxiolytics With Other Major Uses

Several H1 histamine antagonists (e.g., diphenhydra-mine, promethazine, and hydroxyzine) have been used as sedative–hypnotics, since they produce some degree of sedation.

SEDATIVES AND ANXIOLYTICS WITH OTHER MAJOR USES

Antihistamines

Several H1 histamine antagonists (e.g., diphenhydra-mine, promethazine, and hydroxyzine) have been used as sedative–hypnotics, since they produce some degree of sedation. While this sedation is usually considered a side effect of their antihistaminic activity, in some cases the sedation is sufficient to allow the drugs to be used in the treatment of anxiety and sleep disturbances. For these drugs, the anxiolytic properties are thought to be a direct consequence of their ability to produce se-dation.

Hydroxyzine hydrochloride (Atarax, Vistaril) is the antihistamine with the greatest use in the treatment of anxiety. It is often used to reduce the anxiety that is as-sociated with anesthesia and surgery. It also produces sedation, dries mucous membranes (via an anticholiner-gic mechanism), and has antiemetic activity.

β-Adrenoceptor Blocking Agents

β-Adrenoceptor antagonists, such as propranolol (Inderal), have been widely used in the treatment of cardiovascular diseases. These β-blockers also are useful in some forms of anxiety, par-ticularly those that are characterized by somatic symp-toms or by performance anxiety (stage fright). There is general agreement that β-blockers can lessen the sever-ity and perhaps prevent the appearance of many of the autonomic responses associated with anxiety. These symptoms include tremors, sweating, tachycardia, and palpitations.

Antidepressants

Antidepressant drugs, such as the tricyclic antidepres-sants and the selective serotonin reuptake inhibitors (SSRIs), are very important for the treatment of psy-chotic depression . They have been shown to be effective when used in the treatment of several anxiety disorders, including general anxiety, ob-sessive-compulsive disorder, and several phobias, in-cluding agoraphobia. Because the SSRIs are less toxic than the tricyclic antidepressants, their use in the treat-ment of anxiety is safer and less likely to produce seri-ous side effects.

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