Rescue medication for insomnia8/3/2023 ![]() Eszopiclone had the most favorable profile and best evidence to support its use. More specifically, the SMDs were 0.45 (4 weeks) and 0.03 (3 months) for zolpidem, 0.51 (4 weeks) for zopiclone, 0.51 (4 weeks) and 0.63 (3 months) for eszopiclone, and 0.19 (4 weeks) for zaleplon. It included the Z-drugs and found effect sizes ( standardized mean difference (SMD)) ranging from 0.03 to 0.63 for these agents. Effectiveness Ī major systematic review and network meta-analysis of medications for the treatment of insomnia was published in 2022. Efficacy also did not differ between benzodiazepine and Z-drug users. A survey of patients using nonbenzodiazepine Z-drugs and benzodiazepine hypnotic users found that there was no difference in reports of adverse effects that were reported in over 41% of users and, in fact, Z-drug users were more likely to report that they had tried to quit their hypnotic drug and were more likely to want to stop taking Z-drugs than benzodiazepine users. Long-term use is not recommended as tolerance and addiction can occur. A little under a third (31%) of all Americans over 65 years of age are taking Z-drugs. ![]() This has led to the Z-drugs becoming widely prescribed for the treatment of insomnia particularly in elderly patients. They are safer than the older barbiturates especially in overdosage and they may, when compared to the benzodiazepines, have less of a tendency to induce physical dependence and addiction, although these issues can still become a problem. These three drugs are all sedatives used exclusively for the treatment of mild insomnia. The first three nonbenzodiazepine drugs to enter the market were the "Z-drugs", zopiclone, zolpidem and zaleplon. Pharmaceuticals Comparison of nonbenzodiazepines ![]() Some differences exist between the Z-drugs, for example tolerance and rebound effects may not occur with zaleplon. Further research into the safety of nonbenzodiazepines and long-term effectiveness of nonbenzodiazepines has been recommended in a review of the literature. Data is also limited into the long-term effects of nonbenzodiazepines. However, data is limited so no conclusions can be drawn. There is some limited evidence that suggests that tolerance to nonbenzodiazepines is slower to develop than with benzodiazepines. Nonbenzodiazepines have demonstrated efficacy in treating sleep disorders. Some nonbenzodiazepines can be subtype-selective, possibly providing anxiolytic effects with little to no hypnotic or amnesic effects or providing hypnotic effects with little or no anxiolytic effect. Like the benzodiazepines, they exert their effects by binding to and activating the benzodiazepine site of the receptor complex. The nonbenzodiazepines are positive allosteric modulators of the GABA A receptor.
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