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| Sedative | |
|---|---|
| Drug class | |
.jpg) Herbal sedative. | |
| Clinical data | |
| Drugs.com | Drug Classes |
| External links | |
| MeSH | D006993 |
| Legal status | |
| In Wikidata | |
Asedative ortranquilliser[note 1] is a substance that inducessedation by reducingirritability[1] orexcitement.[2] They arecentral nervous system (CNS)depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but the majority of them affect theneurotransmittergamma-aminobutyric acid (GABA). Most sedatives produce relaxing effects by increasing GABA activity.[3]
This group is related tohypnotics. The termsedative describes drugs that serve to calm orrelieve anxiety, whereas the termhypnotic describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging fromanxiolysis to loss of consciousness), they are often referred to collectively assedative–hypnotic drugs.[4]
There is some overlap between the terms "sedative" and "hypnotic".
Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects:
The term "chemicalcosh" (cosh being a term for a blunt weapon such as a club) is sometimes used colloquially for a strong sedative, particularly for:
Doctors andveterinarians 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, they can be a useful adjunct toanalgesics in preparing patients forsurgery, and are commonly given to patients before they areanaesthetized, or before other highly uncomfortable and invasive procedures likecardiac catheterization,endoscopy,colonoscopy.[citation needed]
Some sedatives can cause psychological and physical dependence when taken regularly over a period of time, even at therapeutic doses.[6][7][8][9] Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependencies, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy.[citation needed]
Many sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use 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. Someheroin users may take them either to supplement their drug or to substitute for it.Stimulant users may 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 includesuicides and accidental drug poisonings. Benzodiazepines comparatively have a wider margin of safety and rarely result in overdose unless mixed with other CNS depressants.[10] Accidental deaths sometimes occur when adrowsy,confused user repeats doses, or when sedatives are taken withalcohol.
A study from the United States found that in 2011, sedatives and hypnotics were a leading source of adverse drug events (ADEs) seen in the hospital setting: Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug.[11] A second study noted that a total of 70,982 sedative exposures were reported to U.S.poison control centers in 1998, of which 2310 (3.2%) resulted in majortoxicity 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.[12]
There are also seriousparadoxical reactions that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist ofdepression, with or withoutsuicidal tendencies,phobias, aggressiveness,violent behavior and symptoms sometimes misdiagnosed aspsychosis.[13]
Sedatives and alcohol are sometimes combinedrecreationally or carelessly. Since alcohol is a strong depressant that slowsbrain function anddepresses respiration, the two substances compound each other's actions and this combination can prove fatal.
The long-term use of benzodiazepines may have a similar effect on the brain asalcohol, and are also implicated indepression,anxiety,post-traumatic stress disorder (PTSD),mania,psychosis,sleep disorders,sexual dysfunction,delirium, andneurocognitive disorders (including benzodiazepine-induced persisting dementia which persists even after the medications are stopped).[14] As with alcohol, the effects ofbenzodiazepines on neurochemistry, such as decreased levels ofserotonin andnorepinephrine, are believed to be responsible for their effects on mood and anxiety.[15][16][17][18][19][20] Additionally, benzodiazepines can indirectly cause or worsen other psychiatric symptoms (e.g., mood, anxiety, psychosis, irritability) by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Benzodiazepines are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep, they disruptsleep architecture: decreasing sleep time, delaying time toREM sleep, and decreasing deepslow-wave sleep (the most restorative part of sleep for both energy and mood).[21][22][23]
Sedatives and hypnotics should be avoided in people with dementia,[24] according to themedication appropriateness tool for co‐morbid health conditions in dementia criteria.[25] The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications.[citation needed]
Sedatives can sometimes leave the patient with long-term or short-termamnesia.Lorazepam is one such pharmacological agent that can causeanterograde amnesia.Intensive care unit patients who receive higher doses over longer periods, typically viaIV drip, are more likely to experience such side effects.Additionally, the prolonged use of tranquilizers increases the risk of obsessive and compulsive disorder, where the person becomes unaware whether he has performed a scheduled activity or not, he may also repetitively perform tasks and still re-performs the same task trying to make-up for continuous doubts. Remembering names that were earlier known becomes an issue such that the memory loss becomes apparent.
Sedatives — most commonlyalcohol,[26] but alsoGHB,flunitrazepam (Rohypnol), and to a lesser extent,temazepam (Restoril) andmidazolam (Versed)[27] — have been reported for their use asdate rape drugs (also called aMickey Finn) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses.
Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.[28] 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 offense, and theamnesia produced by the drug makes it difficult for police to interrogate them if they are caught.[citation needed]
