Zopiclone and zaleplon vs benzodiazepines in the treatment of insomnia: Canadian consensus statement

Montplaisir, Jacques; Hawa, Raed; Moller, Henry J.; Morin, Charles M.; Fortin, Mary; Matte, J.; Reinish, Lawrence W.; Shapiro, Colin M.

doi:10.1002/hup.445

Cited by 55 publications

(42 citation statements)

References 66 publications

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“…Rebound insomnia, upon immediate cessation of the hypnotic drug, has been reported with higher doses of zolpidem [43]. This phenomenon has not been reported with therapeutic doses of zopiclone and zaleplon [1,8]. The potential for zolpidem abuse and dependence in insomniacs is being increasingly recognized with warnings on product labels appearing since 2004 [44].…”

Section: Adverse Effectsmentioning

confidence: 99%

“…Insomnia is an underrecognized and undertreated medical condition that leads to lifestyle impairment, loss of occupational productivity, and potential physical harm from accidents as well as exacerbation of other medical conditions. The rate of diagnosed insomnia in the UK and North America is estimated at 5-15 %, with up to 40 % of the population experiencing symptoms of daytime sleepiness [1,2]. Some studies quote that up to a third of elderly North Americans are prescribed either a Z-drug or benzodiazepine for sleep disturbance, an alarming statistic given the risks associated with hypnotics in the elderly [3].…”

Section: Introductionmentioning

confidence: 99%

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The Clinical and Forensic Toxicology of Z-drugs

Gunja

2013

J. Med. Toxicol.

159

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The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines. Their pharmacokinetics approach those of the ideal hypnotic with rapid onset within 30 min and short half-life (1-7 h). Zopiclone with the longest duration of action has the greatest residual effect, similar to short-acting benzodiazepines. Neuropsychiatric adverse events have been reported with zolpidem including hallucinations, amnesia, and parasomnia. Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose. Zdrugs can be detected in blood, urine, oral fluid, and postmortem specimens, predominantly with liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Zaleplon with its ultra-short half-life has been detected in few clinical or forensic cases possibly due to assay unavailability, low frequency of use, and short window of detection. Though Z-drugs have improved pharmacokinetic profiles, their adverse effects, neuropsychiatric sequelae, and incidence of poisoning and death may prove to be similar to older hypnotics.

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Section: Adverse Effectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Clinical and Forensic Toxicology of Z-drugs

Gunja

2013

J. Med. Toxicol.

159

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“…Although, the newer non-benzodiazepine receptor agonist hypnotics differ as they have selective pharmacodynamic properties that add to their safety and tolerability. 15 The major difference between the benzodiazepines and Z drugs is in their structure, unlike benzodiazepine drugs the Z drugs lack the benzene ring, but they still bind at the BDZ receptor. Non-benzodiazepine receptor agonists bind more specifi cally to the alpha-1 subunit of the gammaaminobutyric acid-A (GABA A ) receptor, which is associated with sedation and thus also produces lesser side effects due to this specifi city.…”

Section: Benzodiazepine Receptor Agonist Hypnoticsmentioning

confidence: 99%

“…32 With increasing knowledge of regulation of sleep-wake cycle, researchers are developing newer compounds to treat insomnia that work on pathways that are separate from GABA system. 15 Agomelatine is a newer selective melatonin receptor agonist that interacts with M1/M2 receptors and functions as a 5-HT 2C antagonist. 33 It is indicated for depression.…”

Section: Newer Advances In Treatment Of Insomniamentioning

confidence: 99%

Management of insomnia: current trends

Kaur

Ambwani

Mehta

2014

Int J Basic Clin Pharmacol

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“…15 A similar Canadian document actually goes on to say that the diagnosis of primary insomnia needs to be made by exclusion: by ruling out other conditions that may be causing the sleep disturbance, a decision can be made that the primary problem is the insomnia. 16 Presenting the issues from a public health perspective, Dement and Pelayo 13 provided detailed recommendations for the evaluation of insomnia including differential diagnosis, and a European consensus document related to diagnosis and management outlines the importance of the problem and the apparent lack of attention being paid to the diagnosis and treatment. 17 …”

Section: Morgan K University Of Loughborough Personal Communicationmentioning

confidence: 99%

Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation

Dündar¹,

Boland²,

Strobl³

et al. 2004

Health Technol Assess

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Zopiclone and zaleplon vs benzodiazepines in the treatment of insomnia: Canadian consensus statement

Cited by 55 publications

References 66 publications

The Clinical and Forensic Toxicology of Z-drugs

The Clinical and Forensic Toxicology of Z-drugs

Management of insomnia: current trends

Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation

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