Nonbenzodiazepines-nonbarbiturates

Nonbenzodiazepines-nonbarbiturates

Nonbenzodiazepine-nonbarbiturates act as hypnotics for treatment of simple insomnia. These drugs, which offer no special advantages over other sedatives, include:

• chloral hydrate

• eszopiclone

• ramelton

• zaleplon

• zolpidem.

Diminishing returns

Chloral hydrate and zaleplon lose their effectiveness by the end of the second week. Zolpidem is usually effective for up to 35 days.Eszopiclone and ramelton are approved for long-term treatment of insomnia.

Pharmacokinetics

Nonbenzodiazepines-nonbarbiturates are absorbed rapidly from the GI tract, metabolized in the liver, and excreted in urine.

Pharmacodynamics

The mechanism of action for nonbenzodiazepines-nonbarbiturates isn’t fully known; however, they produce depressant effects simi-lar to barbiturates.

Pharmacotherapeutics

Nonbenzodiazepines-nonbarbiturates are typically used for:

·                 treatment of simple insomnia

·                 sedation before surgery

·                 sedation before EEG studies.

Drug interactions

When nonbenzodiazepines-nonbarbiturates are used with other CNS depressants, additive CNS depression occurs, resulting in drowsiness, respiratory depression, stupor, coma, or death. (See Warning about sleep agents.)

A chlorus of interactions

Chloral hydrate may increase the risk of bleeding in patients tak-ing oral anticoagulants. Use with I.V. furosemide may produce sweating, flushing, variable blood pressure, and uneasiness. (See Adverse reactions to nonbenzodiazepines-nonbarbiturates.)