Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Within the context of the comprehensive treatment of sleep disorders, which includes medical, neurologic, psychiatric, and social interventions, use of medication is often indicated. Among the three benzodiazepine hypnotics that are available in the United States for the treatment of insomnia, flurazepam is effective for both sleep induction and maintenance, and it retains most of its efficacy over a 4-week period of nightly administration; temazepam is effective only for sleep maintenance, and triazolam improves both sleep induction and maintenance with initial but not with continued administration. Rebound phenomena are more frequent and intense with the more rapidly eliminated drug, triazolam, and to a lesser degree with temazepam. Also, with triazolam, certain behavioral side effects, such as amnesia and psychotic-like symptoms, have been reported. With flurazepam, which is a slowly eliminated benzodiazepine, daytime sedation is more frequent than with the other two drugs. When insomnia is secondary to major depression, antidepressant medication should be administered. Methylphenidate, amphetamines, or other stimulant medications are used for the symptomatic treatment of the sleepiness and sleep attacks of narcolepsy and hypersomnia. For cataplexy and the other two auxiliary symptoms of narcolepsy, imipramine or other tricyclics are the drugs of choice. Protriptyline and medroxyprogesterone have been used in treating mild cases of obstructive sleep apnea, but their efficacy is limited. Similarly, for the treatment of central sleep apnea, medroxyprogesterone and acetazolamide have shown only limited effects. Medication for patients with sleepwalking, night terrors, or nightmares should be prescribed judiciously, and primarily when treatment of an underlying psychiatric condition is desired. The neuropharmacology of sleep should also consider drugs that may cause sleep disorders. Medications with sleep disturbing effects include various antihypertensives, bronchodilators, and the energizing antidepressants. Withdrawal of REM-suppressant drugs, such as the barbiturates, may cause nightmares in association with a REM rebound. Occasionally, a drug or a combination of drugs may produce somnambulistic-like activity in some patients.
 ...
PMID:Clinical neuropharmacology of sleep disorders. 333 64

Clonidine was used as an adjunct to baclofen in 55 patients with spasticity due to spinal cord injury. Dosage was held at the minimum effect amount for those who responded. No effect was seen in 24 patients (44%), although 31 (56%) benefitted from the drug. Patients were grouped as quadriplegics or paraplegics, having complete or incomplete lesions. Of all quadriplegics, seven of 11 complete (64%) and 17 of 25 incomplete patients (68%) responded; among the paraplegics, six of 15 complete (40%) and one of four incomplete patients (25%) improved. Side effects were limited to postural hypotension necessitating reduction in dosage in three patients that were successfully treated; in the unsuccessfully treated group, one patient had insomnia, one had dizziness, and one had drowsiness.
 ...
PMID:Clonidine effect on spasticity: a clinical trial. 334 19

Treatment with clonazepam was studied in a group of 20 patients suffering from periodic movements in sleep, in a double-blind parallel group design. Eleven complained of excessive daytime sleepiness, and nine complained of insomnia. Ten patients received clonazepam, and 10 received placebo, over a period of 1 month. Clonazepam (0.5-2 mg per night) proved to be an effective treatment of periodic movements in sleep. Polysomnographic recordings demonstrated a significant decrease in the number of leg movements and a significant improvement in sleep parameters in the clonazepam group as compared with placebo. Subjective responses to treatment corroborated the sleep laboratory findings.
 ...
PMID:Double-blind evaluation of clonazepam on periodic leg movements in sleep. 343 2

Many changes occur in sleep as a function of aging, but it is not known whether these changes result in sleep being less restorative. To examine the sleep restorative process, groups of 12 normal young adults and 12 normal and 12 insomniac male subjects, age 55-71, were totally sleep deprived for 64 hours and then allowed recovery sleep. Response speed, immediate recall, sleepiness, and body temperature were tested at approximately 2300, 0115, 0330, 0530 and 0800 during baseline, sleep loss, and recovery nights. Significant group (age or insomnia) by sleep loss condition interactions were found for reaction time and immediate recall performance measures. Similar significant interactions were found for oral temperature and all EEG sleep variables except total time in bed, percent stage 1, and percent REM. It was concluded that performance recovery following sleep loss was no slower in older subjects than in younger subjects despite very different recovery sleep stage parameters. This implied that aging effects on sleep are developmental rather than degenerative.
 ...
PMID:Sleep and performance in young adults and older normals and insomniacs during acute sleep loss and recovery. 350 53

The effects of an ultra-rapidly eliminated hypnotic (midazolam 7.5-15.0 mg; mean elimination half-life approximately 2 h) and a rapidly eliminated hypnotic (brotizolam 0.125-0.25 mg; mean elimination half-life approximately 5 h) were studied on transient insomnia induced by sleeping in a reclining seat. Rest in the seat did not lead to delay in sleep onset, but there was increased wakefulness and drowsy sleep and less REM sleep. There were no differences in wakefulness or drowsiness between sleep with drugs in the seat and with placebo in bed, but with midazolam, though not with brotizolam, there was a reduction in REM sleep less than or equal to 300 min after sleep onset. Ultra-rapidly and rapidly eliminated compounds used in the management of transient insomnia should be given in doses that are as free as possible from central nervous system depression as indicated by suppression of REM sleep during the early part of the night. Low doses of ultra-rapidly eliminated drugs are indicated for sleep-onset insomnia and for short periods of sleep, while rapidly eliminated hypnotics with elimination half-lives of approximately 5 h have the potential to sustain sleep free of residual effects.
 ...
PMID:Transient insomnia and rapidly eliminated hypnotics. 350 31

A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone and high-dose metoclopramide in the treatment of chemotherapy-induced nausea and vomiting. All entered patients had no prior chemotherapy and all received inpatient emetogenic chemotherapy mainly without cisplatin. Of the 40 evaluable patients, 23 (58%) had no vomiting with dexamethasone compared with only 11 (28%) receiving metoclopramide (P less than 0.025). Dexamethasone was found to have less adverse effect than metoclopramide on patient's appetite and activity (P less than 0.025 and P less than 0.01, respectively). Twenty-one patients (53%) developed mild to severe somnolence with metoclopramide compared to only seven (18%) who experienced this adverse effect with dexamethasone (P less than 0.01). Six patients (15%) developed extrapyramidal manifestations with metoclopramide, but none with dexamethasone. Furthermore, during dexamethasone therapy, patients developed less diaphoresis, insomnia, headache and dizziness. Upon questioning patients about their preference to future use of the antiemetic drug therapy, 28 patients (70%) preferred dexamethasone, two (5%) preferred metoclopramide and 10 (25%) found no difference. We conclude that high-dose dexamethasone has a greater antiemetic activity and is more safe than high-dose metoclopramide in patients receiving emetogenic chemotherapy mainly without cisplatin.
 ...
PMID:Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy. 351 33

Ninety-one insomniacs completed a four-week study of the efficacy and safety of zopiclone (Z), 7.5 mg. Patients were randomly allocated to one of two groups, each of which received placebo (P) during one week of the study. Forty-six subjects received medication in the sequence of ZPZZ, and 45 received it in the sequence of ZZPZ. Twice each week, patients filled out presleep and postsleep questionnaires and reported their morning complaints. Compared with placebo, zopiclone produced statistically significant improvements (P less than 0.05) in sleep induction time, duration of sleep, number of awakenings per night, quality and soundness of sleep, morning state of rest, and daytime sleepiness. Headache, dizziness, nausea, and bitter taste were the predominant complaints. Zopiclone can be considered an efficient and safe hypnotic for chronic insomnia.
 ...
PMID:Zopiclone: a new nonbenzodiazepine hypnotic used in general practice. 352 57

Two benzodiazepine hypnotics, triazolam, 0.25 mg, with a short elimination t1/2, and quazepam, 15 mg, with a long t1/2, were evaluated in 22-night sleep laboratory studies. Quazepam improved sleep significantly during both short- and intermediate-term use. Daytime sleepiness, which decreased with continued use, was the side effect most often associated with quazepam dosing. In contrast, triazolam dosing did not significantly improve any of the major sleep efficiency parameters, and there was a rapid development of tolerance for the drug's slight initial effectiveness. In addition, there were a number of behavioral side effects including amnesia, confusion, and disinhibition. Withdrawal of triazolam was associated with sleep and mood disturbances (rebound insomnia and rebound anxiety), whereas quazepam exerted carryover effectiveness. Thus the data in this study show that the 0.25 mg dose of triazolam, which is being prescribed increasingly, has a profile of side effects that is similar to that of the 0.5 mg dose.
 ...
PMID:Comparison of short and long half-life benzodiazepine hypnotics: triazolam and quazepam. 353 May 86

Five patients with chronic respiratory failure from neuromuscular disease and symptomatic worsening nocturnal hypoventilation were treated with nocturnal ventilation. Home ventilation at night was provided by a volume-cycled positive pressure ventilator attached to a nasal mask originally designed to administer nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea. The device was well tolerated. Symptoms of headache, insomnia/somnolence, and impaired intellectual capacity rapidly disappeared with nocturnal ventilatory support. Daytime arterial PO2 and PCO2 improved after therapy. There are several advantages over commonly used, negative pressure devices for nocturnal ventilation. These include patient synchronization of tidal volume, ease of application, less cumbersome apparatus, more nocturnal patient mobility, and absence of production of upper airway obstruction.
 ...
PMID:Nocturnal positive pressure ventilation via nasal mask. 354 11

Forty-eight normal subjects had sleep recordings and multiple sleep latency tests (an EEG measure of sleepiness) before and after a 12-hour shift of sleep-wake schedule. After 2 baseline days, subjects postponed sleep until 12:00 noon, then for three 24-hour periods were in bed from 12:00 noon until 8:00 PM. Treatment in parallel groups were administered before shifted sleeps. Sleep disturbance was greatest in the last quarter of shifted nights (6.5 to 8.5 hours after medication). Subjects taking placebo showed significant sleep loss on shifted nights and increased sleepiness the next day. Triazolam, 0.5 mg, reversed the sleep loss and consequent daytime sleepiness associated with the shifted sleep schedule. Triazolam, 0.25 mg, was not significantly better than placebo. In a dose-related manner, flurazepam mitigated the insomnia, but carryover effects left both dose groups more sleepy than were the placebo control subjects. Whether these laboratory results are applicable to clinically occurring forms of transient insomnia remains to be seen.
 ...
PMID:Dose-related effects of triazolam and flurazepam on a circadian rhythm insomnia. 374 36


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>