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Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

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Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
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Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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Sedatives and Hypnotics: Overview01:23

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Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
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Sedatives and Hypnotics Drugs: Barbiturates01:20

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Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
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CNS Depressants: Barbiturates and Benzodiazepines01:14

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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Benzodiazepines are a class of anxiolytic drugs known for their rapid efficacy and high therapeutic-to-lethal dose ratio, but with a potential risk of drug dependence. These drugs are lipophilic, allowing for rapid absorption after oral administration, eventually reaching the central nervous system (CNS). Once in the CNS, benzodiazepines bind to the allosteric site of the GABAA receptor. This binding enhances the inhibitory effects of the neurotransmitter GABA. By doing so, they prevent...
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Significant decrease in delirium referrals after changing hypnotic from benzodiazepine to suvorexant.

Masako Tachibana1,2, Toshiya Inada2,3, Masaru Ichida1

  • 1Department of Psychiatry, Nagoya Ekisaikai Hospital, Nagoya, Japan.

Psychogeriatrics : the Official Journal of the Japanese Psychogeriatric Society
|March 1, 2021
PubMed
Summary

Switching from benzodiazepines (BZDs) to suvorexant as a first-line hypnotic significantly reduced delirium referrals in elderly patients. This change in insomnia treatment led to fewer psychiatric consultations for delirium among seniors.

Keywords:
benzodiazepinedeliriumgeneral hospitalhypnoticpsychiatrysuvorexant.

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Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Neurology

Background:

  • Benzodiazepines (BZDs) are associated with delirium, particularly in elderly individuals.
  • Suvorexant is recommended as a preferred hypnotic for older adults due to BZD risks.
  • This study investigates the impact of switching hypnotic medications on delirium referrals in the elderly.

Purpose of the Study:

  • To evaluate if adopting suvorexant as a first-line hypnotic reduces delirium referrals in elderly patients.
  • To compare delirium referral rates before and after the implementation of suvorexant.
  • To assess the safety and efficacy of suvorexant in preventing BZD-induced delirium.

Main Methods:

  • A quasi-experimental study design comparing three consecutive 12-month periods.
  • Period A: Benzodiazepine (BZD) use. Period B: Suvorexant recommended. Period C: Suvorexant adopted as first-line.
  • Delirium referral cases to psychiatry in elderly patients were counted and compared across periods.

Main Results:

  • Delirium referrals in elderly patients decreased from 133 (Period A) to 86 (Period B) and 53 (Period C).
  • A statistically significant annual decrease in delirium referral rates was observed (P = 9.02 × 10-10).
  • No significant confounding factors, other than the change in hypnotics, were identified.

Conclusions:

  • First-line use of suvorexant significantly decreased referrals for delirium in elderly patients.
  • The transition from BZDs to suvorexant represents a successful strategy for reducing delirium in this vulnerable population.
  • Suvorexant appears to be a safer alternative to BZDs for insomnia treatment in the elderly, mitigating delirium risk.