Drug-induced nightmares

Area of Science:

• Pharmacology
• Sleep Medicine
• Adverse Drug Reactions

Background:

• Nightmares are parasomnias characterized by intense anxiety and fear during sleep.
• Drug-induced nightmares are a recognized adverse effect of various medications.
• Distinguishing drug-induced nightmares from other causes can be challenging.

Purpose of the Study:

• To systematically review and evaluate the English-language literature on drug-induced nightmares.
• To identify therapeutic agents most frequently associated with nightmares.
• To explore potential pharmacological mechanisms underlying drug-induced nightmares.

Main Methods:

• Comprehensive literature search of MEDLINE (1966-May 1998) using specific keywords.
• Inclusion of published articles, letters, case reports, and abstracts.
• Causality assessment of case reports using the Naranjo algorithm.
• Evaluation of clinical studies for the frequency of nightmare occurrence as an adverse effect.

Main Results:

• Sedative/hypnotics, beta-blockers, and amphetamines were identified as the most frequently implicated drug classes.
• Dopamine agonists also showed evidence of causality.
• For many implicated agents, a clear pharmacological mechanism for causing nightmares was not apparent.
• Possible mechanisms include REM suppression and dopamine receptor stimulation.

Conclusions:

• Establishing causality for nightmares is complex due to their high incidence in the general population.
• Sedative/hypnotics, beta-blockers, amphetamines, and dopamine agonists are strongly associated with drug-induced nightmares.
• These drug classes possess plausible pharmacological mechanisms that may explain their association with nightmares.