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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess the potential hazards of flurazepam (Dalmane) therapy of insomnia in the elderly, the relation of dosage and patient age to the frequency of flurazepam-attributed adverse reactions was studied in 2,542 hospitalized medical patients. Adverse reactions, predominantly unwanted residual drowsiness, were reported in 78 flurazepam recipients (3.1%). None of the adverse reactions were serious. The frequency of reported toxicity increased with average daily dose, ranging from 1.3% among those receiving less than 15 mg/day to 12.3% at doses of 30 mg/day or more (p less than 0.001). Toxicity increased with age, progressively from 1.9% among those under 60 to 7.1% among those 80 or over (p less than 0.001). Unwanted effects of high-dose flurazepam were observed much more commonly in the elderly. Only 2.0% of those 70 years of age or older experienced adverse reactions at doses under 15 mg/day, as opposed to 39.0% at 30 mg or more per day. Low doses of flurazepam appear to be safe for elderly individuals, but they are susceptible to unwanted central nervous system depression at high doses.
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PMID:Toxicity of high-dose flurazepam in the elderly. 1 61

The safety and efficacy of 0.25 mg triazolam were compared to those of 15 mg flurazepam and placebo in 41 geriatric outpatients suffering from insomnia. The patients were randomly assigned to one of the three treatment groups. The medication was taken at bedtime for 28 days. Tolerance development was also studied. Triazolam was found to be significantly better than placebo in how much the medication helped the patients sleep, in sleep onset, in duration of sleep, number of nighttime awakenings, in quality (depth) of sleep, and in feeling of restfulness in the morning. Triazolam was significantly better than flurazepam in duration of sleep and was rated higher than flurazepam in all other variables. Flurazepam was significantly better than placebo in only two variables--onset of sleep and quality (depth) of sleep. Side effects were reported in each treatment group, and one patient on placebo discontinued because of side effects. There was no decrease in hypnotic effect over this four-week period, therefore, no evidence of tolerance development on either of the active compounds. Both active compounds provided the same amount of relief from insomnia after four weeks as they had after one week. Laboratory analyses and poststudy physical examinations showed no deleterious effects over the four-week period.
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PMID:Comparison of triazolam, flurazepam, and placebo as hypnotics in geriatric patients with insomnia. 1 41

In this two-clinic seven-day double-blind study, 0.5 mg triazolam (Halcion) was compared to flurazepam (Dalmane) in the treatment of insomnia. Two clinical investigators completed 118 outpatients, 61 on triazolam and 57 on flurazepam. Five patients, four on triazolam and one on flurazepam, discontinued because of side effects; and three patients, one on triazolam and two on flurazepam, discontinued because of ineffectiveness of the medication. Analysis of pooled data for the 110 evaluable patients showed that 0.5 mg triazolam was significantly better than 30 mg flurazepam on the following parameters: (1) how much the medication helped the patients sleep, (2) onset of sleep, (3) duration of sleep, (4) evaluation of duration of sleep, and (5) feeling of restfulness in the morning. The trend for all other parameters favored triazolam treatment, but the values did not reach statistical significance. Side effects were similar in both groups, with drowsiness being reported most frequently. No change in efficacy indicating tolerance development during the seven days of drug administration was observed in either group.
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PMID:Multiclinic double-blind comparison of triazolam and flurazepam for seven nights in outpatients with insomnia. 1 92

The effectiveness of nine hypnotic drugs was compared using a standard protocol in separate sleep laboratory drug evaluation studies. All of these drugs were relatively effective in improving sleep with initial and short-term use. However, with intermediate-term use (two weeks), most of the drugs showed a marked decrease in their effectiveness. Following withdrawal, sleep was similar to baseline with most of the drugs, continued to be improved with flurazepam (Dalmane), 30 mg, and worsened beyond baseline levels with triazolam (U33030), 0.5 mg. The determination of a drug's effectiveness with continued use is most important clinically in enabling the physician to rationally and effectively use hypnotic drugs in the adjunctive treatment of insomnia.
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PMID:Comparative effectiveness of nine hypnotic drugs: sleep laboratory studies. 32 88

Insomnia is a symptom requiring medical investigation and the elimination of external and physical causes. Anxiety and/or depression have been shown to be present in most of the patients complaining of inability to sleep. Antidepressant medication with sedating potential is very effective in patients with depressive symptoms when most of the dose is given at bed-time. Most of the sedative-hypnotic drugs disturb the qualitative aspects of sleep and many rapidly produce tolerance. Flurazepam has been shown to be the drug of choice for purely symptomatic insomnia. Except in very transient situational stresses, a psychotherapeutic relationship to investigate the causes of the insomnia may be the most important aspect of the treatment program.
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PMID:Insomnia. 64 69

Insomnia, a more or less chronic sleep disturbance, is a very common symptom in psychiatric patients but also relatively freguent in the general population to a lesser degree. Two broad types of insomnia may often be distinguished: (1) difficulty falling asleep and frequent wakening, characteristic of anxiety states or obsessive worrying; and (2) early morning wakening, sometimes in a panic, suggestive of endogenous depression. The first group of patients respond well to minor tranquilizers and psychotherapy, whereas the second do well with tricyclic anti-depressants. Many studies in sleep laboratories have declineated the stages and cycles of sleep physiology and pathology, especially the importance of REM or dreaming sleep. The clinician should be cautious in the use of hypnotics like barbiturates which suppress REM sleep and produce a rebound increase on withdrawal, as well as problems of dependence of habituation. Flurazepam and chloral hydrate are considerably safer in this respect. Understanding sleep neurophysiology and biochemistry permits appropriate individual clinical management for both psychiatric patients and medical patients with conditions like peptic ulcer and nocturnal angina pectoris.
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PMID:Insomnia: often a therapeutic challenge. 114 59

The "revolution" in pharmacologic treatment of insomnia began in 1970 with the availability of flurazepam, the first of the benzodiazepine hypnotics. Flurazepam largely replaced all other hypnotics during the decade of the 1970s. The second revolution began in the early 1980s as shorter half-life hypnotics, triazolam and temazepam, became available and began to replace flurazepam. The decade of the 1990s will probably see a more balanced pattern of benzodiazepine hypnotic use, as well as use of newer nonbenzodiazepine hypnotics. Among available benzodiazepines, all have the capacity to produce dose- and concentration-dependent sedation, drowsiness, performance impairment, and amnesia. Benzodiazepine-induced amnestic effects are characterized by either impairment of information acquisition, impairment of consolidation and storage, or both. In general, apparent clinical differences among benzodiazepine hypnotics are explained by differences in pharmacokinetic properties of absorption, distribution, elimination, and clearance.
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PMID:Pharmacology of benzodiazepine hypnotics. 131 29

Insomnia is commonly encountered in general medical practice, but little is known about how primary care physicians manage this problem. We reviewed medical records describing 536 patient encounters in which either triazolam (Halcion) or flurazepam (Dalmane) was prescribed for outpatient use. Only 12% of the progress notes written by internists or surgeons contained even a remote reference to sleep, whereas 74% of psychiatrist's notes contained at least some sleep symptom documentation. In a multivariate analysis including the number of medical and psychiatric diagnoses, patient age, and physician gender, only the prescriber department was independently associated with the presence of symptom documentation. We also found that 30% of the prescriptions written by internists or surgeons were for inappropriately large quantities of these drugs (180 or more doses) compared with 6% of the prescriptions written by psychiatrists. We conclude that the evaluation of insomnia by nonpsychiatrists is often incomplete and that hypnotic drugs may be inappropriately prescribed by these physicians. Further efforts are needed to improve the management of insomnia by primary care physicians in the outpatient setting.
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PMID:Diagnosis and treatment of outpatient insomnia by psychiatric and nonpsychiatric physicians. 162 73

This is a review and update on hypnotics. Insomnia is a symptom of many underlying conditions which have to be evaluated before resorting to medication. Hypnotics are useful for short term treatment. The benzodiazepines have replaced the barbiturates which have a low therapeutic index. The action of benzodiazepines depends on their absorption rate, lipophilicity, half-life and metabolites. They induce sleep, prolonged sleep time and reduced night wakenings. They increase stage 2 sleep, and reduce stage 1, 3, 4 and REM (Rapid Eye Movement) sleep. Flurazepam, triazolam and midaolam are described. The benzodiazepines suffer from many unwanted effects which include tolerance, dependence, withdrawal symptoms, rebound insomnia, hang over effect, alteration of memory process and synergism with ethanol. The ideal hypnotic should be free from these drawbacks. Three new generation hypnotics quazepam, zopiclone and zolpidem are described. Drugs suitable for long term hypnotic medication include antipsychotics, antidepressants and antihistamines.
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PMID:Insomnia: drug treatment. 167 17

This study examined the effects of flurazepam on arousal threshold and on quality of sleep during nights in which arousal threshold studies were performed. Ten patients with subjective insomnia received 30 mg flurazepam or placebo on nights in which arousal thresholds in response to electronic tones or a recording of the subjects' names were determined. Arousal thresholds differed across waking and sleep stages, but there was less difference in response to the subjects' names than to electronic tones. Flurazepam raised arousal thresholds to both stimuli, but did not selectively influence response in any individual sleep stage. Flurazepam did not alter subjects' estimates of elapsed time or duration of sleep between tests.
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PMID:Effects of flurazepam on sleep, arousal threshold, and the perception of being asleep. 313 7


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