Appropriate Use and Abuse of Sedative-Hypnotic Drugs

ZHENG Jun-wei, MENG Shi-qiu, LIU Wang-yue, CHANG Xiang-wen, SHI Jie

Abstract

The incidence of insomnia has been increasing in recent years. In addition, due to the impact of the COVID-19 pandemic, more and more people are experiencing a variety of insomniac problems, including having difficulty in sleep initation, waking up too early, and short sleep duration. Chronic insomnia may seriously affect patients' life and work, increase their risks of developing physical and mental illnesses, and cause crushing social and economic burdens. Sedative-hypnotics, including benzodiazepine agonists, melatonin receptor agonists, orexin receptor antagonists, and antidepressants with hypnotic effects, are widely used to treat most patients suffering from insomnia. However, there is the phenomenon of the non-medical use and abuse of sedative-hypnotic drugs, especially benzodiazepine receptor agonists. The abuse of sedative-hypnotic drugs may lead to mental and physical dependence, cognitive impairment, depression and anxiety, as well as an increased risks of falls and death. Therefore, drug regulatory authorities in China and other countries have issued relevant policies to reinforce regulation. Herein, we reviewed the prevalent use and safety of sedative-hypnotic drugs and proposed suggestions concerning their appropriate use. Both the efficacy and safety of sedative-hypnotic drugs should be carefully considered so that patients suffering from insomnia receive thorough and prompt treatment and the problem of potential abuse of sedative-hypnotic drugs is assessed in an objective and scientific manner. We also hope to provide references for the standardized clinical use of insomnia drugs.

 

Keywords: Insomnia, Sedative-hypnotic drugs, Abuse, Addictiveness, Safety, Appropriate use

 

Full Text:

PDF


References


De CRESCENZO F, D'ALÒ G L, OSTINELLI E G, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet,2022,400(10347): 170–184. doi: 10.1016/s0140-6736(22)00878-9.

PERLIS M L, POSNER D, RIEMANN D, et al. Insomnia. Lancet,2022, 400(10357): 1047–1060. doi: 10.1016/S0140-6736(22)00879-0.

LIANG M, GUO L, HUO J, et al. Prevalence of sleep disturbances in Chinese adolescents: a systematic review and meta-analysis. PLoS One, 2021,16(3): e0247333. doi: 10.1371/journal.pone.0247333.

SHI L, LU Z A, QUE J Y, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Netw Open,2020, 3(7): e2014053. doi: 10.1001/jamanetworkopen.2020.14053.

MILANI S A, RAJI M A, CHEN L, et al. Trends in the use of benzodiazepines, Z-hypnotics, and serotonergic drugs among us women and men before and during the COVID-19 pandemic. JAMA Netw Open,2021,4(10): e2131012. doi: 10.1001/jamanetworkopen.2021.31012.

LAPEYRE-MESTRE M, BOUCHER A, DAVELUY A, et al. Addictovigilance contribution during COVID-19 epidemic and lockdown in France. Therapie,2020,75(4): 343–354. doi: 10.1016/j.therap.2020.06. 006.

BEGUM M, GONZALEZ-CHICA D, BERNARDO C, et al. Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018. Br J Gen Pract,2021,71(712): e877–e886. doi: 10.3399/bjgp.2021.0054.

WESSELHOEFT R, RASMUSSEN L, JENSEN P B, et al. Use of hypnotic drugs among children, adolescents, and young adults in Scandinavia. Acta Psychiatr Scand,2021,144(2): 100–112. doi: 10.1111/acps.13329.

BLIDDAL M, KILDEGAARD H, RASMUSSEN L, et al. Melatonin use among children, adolescents, and young adults: a Danish nationwide drug utilization study. Eur Child Adolesc Psychiatry,2022. doi: 10.1007/s00787-022-02035-1.

LUGOBONI F, MIRIJELLO A, FACCINI M, et al. Quality of life in a cohort of high-dose benzodiazepine dependent patients. Drug Alcohol Depend,2014,142: 105–109. doi: 10.1016/j.drugalcdep.2014.06.020.

PETURSSON H, LADER M H. Psychological impairment and low-dose benzodiazepine treatment. Br Med J (Clin Res Ed),1982,285(6344): 815–816. doi: 10.1136/bmj.285.6344.815-d.

ASHTON H. Protracted withdrawal syndromes from benzodiazepines. J Subst Abuse Treat,1991,8(1/2): 19–28. doi: 10.1016/0740-5472(91) 90023-4.

SOYKA M. Treatment of benzodiazepine dependence. N Engl J Med, 2017,376(12): 1147–1157. doi: 10.1056/NEJMra1611832.

TAN K R, BROWN M, LABOUÈBE G, et al. Neural bases for addictive properties of benzodiazepines. Nature,2010,463(7282): 769–774. doi: 10. 1038/nature08758.

VINKERS C H, OLIVIER B. Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype-selective GABA(A) receptor modulators? Adv Pharmacol Sci,2012,2012: 416864. doi: 10. 1155/2012/416864.

UUSI-OUKARI M, KORPI E R. Regulation of GABA(A) receptor subunit expression by pharmacological agents. Pharmacol Rev,2010, 62(1): 97–135. doi: 10.1124/pr.109.002063.

GRAVIELLE M C. Activation-induced regulation of GABAA receptors: is there a link with the molecular basis of benzodiazepine tolerance?Pharmacol Res,2016,109: 92–100. doi: 10.1016/j.phrs.2015.12.030.

HAJAK G, MÜLLER W E, WITTCHEN H U, et al. Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction,2003,98(10): 1371–1378. doi: 10.1046/j.1360-0443.2003.00491.x.

SCHIFANO F, CHIAPPINI S, CORKERY J M, et al. An insight into z-drug abuse and dependence: an examination of reports to the European medicines agency database of suspected adverse drug reactions. Int J Neuropsychopharmacol,2019,22(4): 270–277. doi: 10.1093/ijnp/pyz007.

SABE M, KASHEF H, GIRONI C, et al. Zolpidem stimulant effect: induced mania case report and systematic review of cases. Prog Neuropsychopharmacol Biol Psychiatry,2019,94: 109643. doi: 10.1016/j. pnpbp.2019.109643.

ATKIN T, COMAI S, GOBBI G. Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discovery. Pharmacol Rev,2018,70(2): 197–245. doi: 10.1124/pr.117.014381.

GROSSHANS M, MUTSCHLER J, LUDERER M, et al. Agomelatine is effective in reducing insomnia in abstinent alcohol-dependent patients. Clin Neuropharmacol,2014,37(1): 6–8. doi: 10.1097/wnf.0000000000007


Refbacks

  • There are currently no refbacks.