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Drug-induced nightmares

D F Thompson1, D R Pierce

  • 1Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Oklahoma City 73102, USA. thompsd@swosu.edu

The Annals of Pharmacotherapy
|February 11, 1999
PubMed
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This review identifies sedative/hypnotics, beta-blockers, and amphetamines as common causes of drug-induced nightmares. Dopamine agonists may also trigger these adverse sleep events.

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.

Related Experiment Videos

  • 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.