Sedative

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

A sedative is a substance that depresses the central nervous system (CNS), resulting in calmness, relaxation, reduction of anxiety, sleepiness, and slowed breathing, as well as slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Sedatives may be referred to as tranquilizers, depressants, anxiolytics, soporifics, sleeping pills, or sedative-hypnotics. This, however, may be inaccurate as sedatives are a type of depressant as are tranquilizers which are mild in their action compared to that of sedatives. Also, sedatives only act as hypnotics (sleep-inducing drugs)in relatively high doses. Sedatives can be abused to produce an overly-calming effect (alcohol being the classic and most common sedating drug). At high doses or when they are abused, many of these drugs can cause unconsciousness (see hypnotic) and even death.

Types of sedatives

• Antidepressants
  • mirtazapine (Remeron)
  • trazodone (Desyrel)
• Barbiturates
  • amobarbital (Amytal)
  • pentobarbital (Nembutal)
  • secobarbital (Seconal)

• Benzodiazepines ("minor tranquilizers")
  • alprazolam (Xanax)
  • bromazepam (Lexotan)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • estazolam (Prosom)
  • flunitrazepam (Rohypnol)
  • lorazepam (Ativan)
  • midazolam (Versed)
  • nitrazepam (Mogadon)
  • oxazepam (Serax)
  • triazolam (Halcion)
  • temazepam (Restoril, Normison, Planum, Tenox and Temaze)
  • chlordiazepoxide (Librium)

• Typical antipsychotics ("major tranquilizers")
  • chlorpromazine (Thorazine, Largactil)
  • fluphenazine (Prolixin)
  • haloperidol (Haldol)
  • loxapine succinate (Loxitane)
  • perphenazine (Etrafon, Trilafon)
  • prochlorperazine (Compazine)
  • thiothixene (Navane)
  • trifluoperazine (Stelazine, Trifluoperaz)
  • zuclopentixol (Cisordinol)

• Atypical antipsychotics
  • clozapine (Clozaril)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon) (May cause somnolence in some, while causing insomnia in others)

• Sedating antihistamines
  • clemastine
  • doxylamine
  • diphenhydramine (Benadryl)
  • hydroxyzine (Atarax)
  • niaprazine
  • promethazine
  • pyribenzamine
  • cyproheptadine

• Herbal sedatives
  • ashwagandha
  • catnip
  • kava (Piper methysticum)
  • mandrake
  • marijuana
  • valerian

• Solvent sedatives
  • chloral hydrate (Noctec)
  • diethyl ether (Ether)
  • ethyl alcohol (alcoholic beverage)
  • gamma-hydroxybutyrate (GHB)
  • methyl trichloride (Chloroform)

• Nonbenzodiazepine sedatives
  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • zopiclone (Imovane, Zimovane)

• Uncategorized sedatives
  • ethchlorvynol (Placidyl)
  • glutethimide (Doriden)
  • ketamine (Ketalar, Ketaset)
  • methaqualone (Sopor, Quaalude)
  • methyprylon (Noludar)
  • ramelteon (Rozerem)

Therapeutic use

Doctors and nurses often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization , colonoscopy or MRI. They increase tractability and compliance of children or troublesome or demanding patients.

Patients in intensive care units are almost always sedated (unless they are unconscious from their condition anyway)

Sedative dependence

All sedatives can cause physiological and psychological dependence when taken regularly over a period of time, even at therapeutic doses. Dependent users may get symptoms ranging from restlessness, insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although there is no physical dependence. In both types of dependences, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy. (see Sedative Dependence).

Abuse and overdoses

All sedatives can be abused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative abuse due to their widespread "recreational" or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Heroin users take them either to supplement their drug or to substitute for it. Stimulant users frequently take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol. In the U.S., in 1998, a total of 70,982 sedative exposures were reported to U.S. poison control centers, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.

See also Other non-therapeutic use.

Sedatives and alcohol

Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions synergistically and this combination can prove fatal.

Lookalikes

Lookalikes, or pills made to mimic the appearance and the effects of authentic sedatives, are sold on the street. Lookalikes may contain over-the-counter drugs, such as antihistamines, that cause drowsiness. Since the actual composition is unknown, neither the intensity of the primary effect nor the range of side effects can be predicted.

Sedatives and amnesia

Sedation can sometimes leave the patient with long-term or short-term amnesia. Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods of time, typically via IV drip, are more likely to experience such side effects.

Sedative drugs and crime

The sedatives GHB, Flunitrazepam (Rohypnol), and to a lesser extent, temazepam (Restoril), and midazolam (Versed) are known for their use as date rape drugs (also called a Mickey), administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people, indeed statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.

Cases of criminals taking rohypnol themselves before they commit crimes have also been reported, as the loss of inhibitions from the drug may increase their confidence to commit the offence, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught.