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14-September-2008 18:02:40 - Sedative This article or section is missing citations or needs footnotes. Using inline citations helps guard against copyright violations and factual inaccuracies. August 2008 A sedative, or, more specifically, a sedative-hypnotic, is a substance that depresses the central nervous system CNS,1 resulting in calmness, relaxation, reduction of anxiety, sleepiness, and slowed breathing, and possibly - at higher doses - slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Doses of sedative-hypnotics when used as a hypnotic to induce sleep tend to be higher than those used to relieve anxiety. Sedative-hypnotics may be referred to as tranquilizers, depressants, anxiolytics, soporifics, and sleeping pills. Sedative-hypnotics can be abused to produce an overly-calming effect alcohol being the classic and most common sedating drug. At high doses or when they are abused, many of these drugs can cause unconsciousness see hypnotic and even death. Contents 1 Types of sedatives 2 Therapeutic use 3 Sedative-hypnotic dependence 4 Misuse and abuse 5 Dangers of combining sedatives and alcohol 6 Lookalikes 7 Sedatives and amnesia 8 Sedative-hypnotic drugs and crime 9 References Types of sedatives Sedative-hypnotics Barbiturates amobarbital Amytal pentobarbital Nembutal secobarbital Seconal Phenobarbitol Luminal Benzodiazepines minor tranquilizers alprazolam Xanax bromazepam Lexotan clonazepam Klonopin diazepam Valium estazolam Prosom flunitrazepam Rohypnol lorazepam Ativan midazolam Versed nitrazepam Mogadon oxazepam Serax triazolam Halcion temazepam Restoril, Normison, Planum, Tenox, and Temaze chlordiazepoxide Librium Herbal sedatives ashwagandha catnip kava Piper methysticum mandrakecitation needed marijuana valerian Solvent sedatives chloral hydrate Noctec diethyl ether Ether ethyl alcohol alcoholic beverage methyl trichloride Chloroform Nonbenzodiazepine sedatives eszopiclone Lunesta zaleplon Sonata zolpidem Ambien zopiclone Imovane, Zimovane Uncategorized sedative-hypnotics clomethiazole clomethiazole gamma-hydroxybutyrate GHB Thalidomide ethchlorvynol Placidyl glutethimide Doriden ketamine Ketalar, Ketaset methaqualone Sopor, Quaalude methyprylon Noludar ramelteon Rozerem Drugs which are not sedative-hypnotics The following drugs are not classed as sedative-hypnotics but may cause drowiness. These drugs include narcotic opiate analgesics, some antidepressants and neuroleptics. Antidepressants mirtazapine Remeron trazodone Desyrel Typical antipsychotics major tranquilizers chlorpromazine Thorazine, Largactil fluphenazine Prolixin haloperidol Haldol loxapine succinate Loxitane perphenazine Etrafon, Trilafon prochlorperazine Compazine thiothixene Navane trifluoperazine Stelazine, Trifluoperaz zuclopentixol Cisordinol Atypical antipsychotics clozapine Clozaril olanzapine Zyprexa quetiapine Seroquel risperidone Risperdal ziprasidone Geodon May cause somnolence in some, while causing insomnia in others Sedating antihistamines clemastine doxylamine diphenhydramine Benadryl hydroxyzine Atarax niaprazine promethazine pyribenzamine cyproheptadine Opiates or semi-synthetic opioids Codeine Diamorphine Hydrocodone Vicodin Morphine Oxycodone Percodan Therapeutic use Doctors and nurses often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization , colonoscopy or MRI. They increase tractability and compliance of children or troublesome or demanding patients. Patients in intensive care units are almost always sedated unless they are unconscious from their condition anyway Sedative-hypnotic dependence All sedative-hypnotics can cause physiological and psychological dependence when taken regularly over a period of time, even at therapeutic doses.2345 Dependent users may get withdrawal symptoms ranging from restlessness, insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although there is no physical dependence. In both types of dependences, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy. see Sedative Dependence. Misuse and abuse See main article: Drug overdose Further information: Combined Drug Intoxication See also: Barbiturate#Other non-therapeutic use and Barbiturate#Recreational misuse and abuse All sedatives can be misused and abused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative abuse due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Heroin users take them either to supplement their drug or to substitute for it. Stimulant users frequently take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol. In the U.S., in 1998, a total of 70,982 sedative exposures were reported to U.S. poison control centers, of which 2310 3.2% resulted in major toxicity and 89 0.1% resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs. There are also serious paradoxical complications that may occur in conjunction with the use of sedatives that to some individuals result in results that are unexpected and the opposite to the effects expected. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.6 Dangers of combining sedatives and alcohol Further information: Combined Drug Intoxication Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions synergistically and this combination can prove fatal. Lookalikes Lookalikes, or pills made to mimic the appearance and the effects of authentic sedatives, are sold on the street. Lookalikes may contain over-the-counter drugs, such as antihistamines, that cause drowsiness. Since the actual composition is unknown, neither the intensity of the primary effect nor the range of side effects can be predicted. Sedatives and amnesia Sedation can sometimes leave the patient with long-term or short-term amnesia. Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods of time, typically via IV drip, are more likely to experience such side effects. Sedative-hypnotic drugs and crime The sedative-hypnotics GHB, alcohol, Flunitrazepam Rohypnol, and to a lesser extent, temazepam Restoril, and midazolam Versed7 Alcohol is the most common sedative-hypnotic drug involved in cases of drug rape.8 Sedative-hypnotics are well known for their use as date rape drugs also called a Mickey and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people. Indeed statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.9 Cases of criminals taking rohypnol themselves before they commit crimes have also been reported, as the loss of inhibitions from the drug may increase their confidence to commit the offence, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught. References ^ Dorlands Medical Dictionary:sedative. ^ Yi PL; Tsai CH, Chen YC, Chang FC Mar 2007. Gamma-aminobutyric acid GABA receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration. J Biomed Sci 14 2: 285-97. doi:10.1007/s11373-006-9137-z. PMID 17151826. ^ Ebert B; Wafford KA, Deacon S Dec 2006. Treating insomnia: Current and investigational pharmacological approaches. Pharmacol Ther 112 3: 612-29. doi:10.1016/j.pharmthera.2005.04.014. PMID 16876255. ^ Sarrecchia C; Sordillo P, Conte G, Rocchi G Oct-Dec 1998. Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication. Ann Ital Med Int 13 4: 237-9. PMID 10349206. ^ Proudfoot H; Teesson M; Australian National Survey of Mental Health and Wellbeing Oct 2002. Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing. Soc Psychiatry Psychiatr Epidemiol 37 10: 451-6. doi:10.1007/s00127-002-0576-1. PMID 12242622. ^ Benzodiazepines: Paradoxical Reactions Long-Term Side-Effects ^ Negrusz A; Gaensslen RE. Aug 2003. Analytical developments in toxicological investigation of drug-facilitated sexual assault. Analytical and bioanalytical chemistry. 376 8: 1192-7. doi:10.1007/s00216-003-1896-z. PMID 12682705. ^ Weir E. 10. Drug-facilitated date rape 165 1: 80. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.. PMID 11468961. ^ Thompson, Tony 19 December 2004. 'Rape drug' used to rob thousands, The Observer. Retrieved on 2008-05-08. v d e Major drug groups Gastrointestinal tract/metabolism A stomach acid Antacids, H2 antagonists, Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs B Antithrombotics Anticoagulants, Antiplatelets, Thrombolytics Antihemorrhagics Cardiovascular system C cardiac therapy/antianginals Cardiac glycosides, Antiarrhythmics, Cardiac stimulant Antihypertensives Diuretics Vasodilators Beta blockers renin-angiotensin system ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors Antihyperlipidemics Skin D Emollients Cicatrizant Antipruritics Reproductive system G Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system H Corticosteroids Sex hormones Thyroid hormones Antithyroid agent Infections and infestations J, P Antibiotics Antivirals Vaccines Antifungals Antiparasitic Antiprotozoals, Anthelmintics Malignant and immune disease L Anticancer agents Immunostimulators Immunosuppressants Muscles, bones, and joints M Anabolic steroids Anti-inflammatories NSAID Antirheumatics Corticosteroids Muscle relaxants Brain and nervous system N Anesthetics General, Local Analgesics Anticonvulsants Mood stabilizers Psycholeptic Anxiolytics, Antipsychotics, Hypnotics/Sedatives Psychoanaleptic Antidepressants, Stimulants/Psychostimulants Respiratory system R Bronchodilators Decongestants H1 antagonists Other ATC V Antidotes Contrast media Radiopharmaceuticals Dressing v d e Psycholeptics: hypnotics and sedatives N05C GABAA receptor Barbiturates Allobarbital - Amobarbital - Aprobarbital - Barbital - Butobarbital - Cyclobarbital - Ethallobarbital - Heptabarbital - Hexobarbital - Methohexital - Pentobarbital - Phenobarbital - Proxibarbal - Reposal - Secobarbital - Talbutal - Thiopental - Vinylbital - Vinbarbital Benzodiazepines Brotizolam - Cinolazepam - Doxefazepam - Estazolam - Flunitrazepam - Flurazepam - Flutoprazepam - Loprazolam - Lormetazepam - Nitrazepam - Nimetazepam - Midazolam - Quazepam - Temazepam - Triazolam Nonbenzodiazepines CL-218,872 - Eszopiclone - Indiplon - Necopidem - Pazinaclone - ROD-188 - Saripidem - Suproclone - Suriclone - SX-3228 - U-89843A - U-90042 - Zaleplon - Zolpidem - Zopiclone Piperidinediones Glutethimide - Methyprylon - Pyrithyldione Quinazolinones Afloqualone - Cloroqualone - Diproqualone - Etaqualone - Mebroqualone - Mecloqualone - Methaqualone - Methylmethaqualone Neuroactive steroids Acebrochol - Allopregnanolone - Alphadolone - Alphaxolone - Ganaxolone - Hydroxydione - Minaxolone - Org 20599 - Tetrahydrodeoxycorticosterone Alpha-2 adrenergic receptor Alpha-adrenergic agonist 4-NEMD - Clonidine - Dexmedetomidine - Lofexidine - Medetomidine - Romifidine - Tizanidine - Xylazine Melatonin receptor Melatonin Agomelatine - Melatonin - Ramelteon Histamine receptor Acetylcholine receptor Antihistamines Anticholinergics Doxylamine - Hydroxyzine - Diphenhydramine - Bromodiphenhydramine - Carbinoxamine - Orphenadrine - Niaprazine - Phenyltoloxamine - Propiomazine - Pyrilamine - Scopolamine GABAB receptor / GHB receptor GHB Type Aceburic acid - GABOB - GHB Sodium Oxybate, Xyrem® - GBL - 1,4-Butanediol - 3-Chloropropanoic acid Other receptors/ ungrouped Aldehydes Acetylglycinamide chloral hydrate - Chloral hydrate - Chloralodol - Dichloralphenazone - Paraldehyde - Petrichloral Alkynes Centalun - Ethchlorvynol - Ethinamate - Hexapropymate - Methylpentynol Carbamates Meprobamate - Carisoprodol - Tybamate - Methocarbamol Other 2-Methyl-2-butanol - Acecarbromal - Apronal - Bromides - Bromisoval - Carbromal - Clomethiazole - Embutramide - Etomidate - Gaboxadol - Loreclezole - Mephenoxalone - Sulfonmethane - Trichloroethanol - Triclofos - Valerian - Valnoctamide - Trazadone Retrieved from http://en..org/wiki/Sedative Categories: SedativesHidden categories: Articles with statements since August 2008 | All articles with statements | Articles with statements since July 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Türkçe ÄŒesky Deutsch Español Ù?ارسی Français LatvieÅ¡u ‪Norsk bokmÃ¥l‬ Português РуÑ?Ñ?кий СрпÑ?ки / Srpski Suomi Svenska This page was last modified on 9 September 2008, at 09:23
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