Talk:Hypnotic

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This[edit]

This info seems to all be contained in sedative (aka sedative-hypnotic). The categories might be merged, as well. Terrace4 09:56, 27 May 2006 (UTC)

Hypnosis is a distinct neurological state, different from sedation...no merging — Preceding unsigned comment added by 71.56.15.91 (talkcontribs) 05:32, 16 June 2006 (UTC)
Hypnosis may be a different state, but the drugs called sedatives seem mostly the same as hypnotics, which is why they're called sedative-hypnotics. Terrace4 15:06, 17 June 2006 (UTC)
While some sedative-hypnotic drugs are used for the same purposes, Some drugs are almost exclusively used as hypnotics. Some drugs are also used exclusively as sedatives. For example, a hypnotic is used when someone has an endoscopic exploration of the stomach and needs to be responsive, not asleep, and generaly have no knowledge/recolection of the extremely unlpleasent event. A sedative would not be appropriate in such a situation. Just look up different drugs in the Merck index. Some will be listed as sedative-hypnotic, some will be listed as sedative, and some will be listed as hypnotic. So NO, they are NOT the same and certainly should not be merged into one article. Check the most current Physicians Desk Reference, or even an older copy published since 1975 or so.
Please, Forgive me for using laymen's terms, I just had to get the point across to the people who think sedatives and hypnotics SEEM like the same thing. I'm no doctor YET, but based on the merits of two of the above statements, I don't think anyone else on this discussion page is either. — Preceding unsigned comment added by 71.30.176.100 (talkcontribs) 15:14, 1 July 2006 (UTC)
I am not a doctor, however, I am a patient with a lot of experience using most of the drugs listed in this article for discussion. First of all, I do not think they should be merged together. This is the problem I see from a prospective of REAL USAGE, that being, NOT ALL THESE DRUGS WORK THE SAME WAY NOR DO THEY ALL PROVIDE THE SAME RESULTS OR METABOLISM. For example, if I were to take Chloral Hydrate, I would become so disoriented after just a few doses, that I would become completely hypnotic and I would continue to digest them until the final result would be my death, (true experience). I am a poor metabolizer for CYP450 2D6, which causes a build-up of this drug into my system. THIS IS THE PROBLEM WITH THIS WHOLE DISCUSSION, MOST OF THESE DRUGS ARE METABOLIZED VIA THE 2D6 PATHWAY. I was given this medication to help me sleep, which it did - too well. However, it displays the characteristics for a Hypnotic - too well. This particular drug could be merged in my opinion. BUT NOT ALL THE DRUGS IN THE CATEGORY LIST FIT INTO THE PROBLEMATIC SYMPTOMS WHICH CHLORAL HYDRATE DOES. I have Chronic Insomnia, so I have to take something. I have inherited a disorder known as, Essential Tremors, which the only known treatment, other than brain surgery, are the benzodiazopines, and a few others with much worse side-effects. I have taken Clonazepam, 3mg daily, going on five years. Clonazepam is neither a sedative nor a hypnotic, in my personal opinion. In my experience, it is a tranquilizer. Valium: Doctors wouldn't be able to safely give me a dose high enough that would cause me to sleep. There are just TOO MANY VARIATIONS IN THE RESULTS OF THE DIFFERENT DRUGS, AND TO A GIVEN INDIVIDUAL, (probably not unlike a lot of drugs). However, we have a problem in this country, I haven't been to any others so I can't speak for them, IN LUMPING ALL PEOPLE TOGETHER FOR A CERTAIN DRUG, OR VISA VERSA. NOT EVERYONE IS GOING TO RESPOND TO THE SAME DRUG AS THE NEXT. YET, WE CLASSIFY A CERTAIN DRUG AND EXPECT IT TO WORK THE SAME WAY AT THE SAME DOSAGE. EVERY DOCTOR at the University School of Medicine that treated me, (where I was being treated for Depression), and not one of them, even though I was intolerant to all the drugs in the Anti-depressants class,(which are metabolized via CPY450-2D6), ever considered that I might have a metabolizing problem! I find that incredibly ignorant and dangerous! In my particular situation, any drug that uses only the 2D6 pathway for metabolizing these drugs, if given to me long enough, will kill me! So, my point: I don't believe medications can so lightly be merged any more than the "next person" is going to respond as I did. My personal opinion: Classify them, what they have been created for and used for; but only one thing has ever been written in stone. I believe, especially on this topic of Hypnotics and sedation, THAT A LOT MORE STUDY NEEDS TO BE DONE IN THE FIELD OF METABOLISM and the effect that has on whether a drug is a HYPNOTIC IN THE TRUE SENSE, OR JUST A MERE TRANQUILIZER, such as as Clonazepam. Very, very few of the so-called, "tranquilizers" are a true Hypnotic FOR ME. It may be different FOR YOU. (Please excuse the length of this article. Thank you for your patience). — Preceding unsigned comment added by Cinderalla (talkcontribs) 19:15, 8 October 2006 (UTC)

Hypnotics are NOT general anesthetics!![edit]

Can someone edit the page as it gives the impression that hypnotic drugs are used for surgury- they are NOT

Hypnotic drug: Diphenhydramine; chloral hydrate; temazepam; pentobarbital


General Anesthetic: Propofol; ketamine; phenobarbital

"Sedatives" should also be replaced with Anxiolytics so they dont get confused with hypnotics.

there are a lot of grey areas yes: but somethings (like diphenhydramine) hbelong to one class only.


Sedatives = depressants, lower excitation

Anxyolitics = those drugs used for panic and anxiety disorders, eg Diazepam

Hypnotics = "Sleeping Pills"

Tranqulizer = Powerful sedative with anesthetic properties (Ketamine) — Preceding unsigned comment added by 172.203.46.213 (talkcontribs) 02:27, 19 December 2006 (UTC)

Opioids as hypnotics?[edit]

While certain opioids (namely some of the fentanyl derivatives, such as sufentanil or remifentanil) do have pronounced hypnosedative effects in doses used in anesthesiology (sic! generaly higher than those for pain control), and while most potent opioids, if overdosed, do induce strong sedation or even coma, in context of pharmaco-hypnosis, no opioids known to me are used. That is, if primary (i.e., not due to pain) insomnia is treated, than not by opioids (and yes, I am aware of the ancient use of opium as sopophoric..).--84.163.69.91 (talk) 14:26, 17 November 2007 (UTC)

They appear to be from a batch of indiscriminate examples (from the appearance of it, the category {{Hypnotics and sedatives}} at the end of the page). I put in more reasonable ones (I think laughing gas was in there before! Yikes.)
Resolved: meteor_sandwich_yum (talk) 04:55, 10 February 2014 (UTC)

Merge proposal[edit]

I think that the article hypnotic should be merged into the sedative article and renamed to sedative hypnotic. Sedative hypnotic drugs are basically the same thing, only that hypnotics tend to be prescribed at higher doses to induce sleep and tend to be shorter acting. For example diazepam is long acting and thus is mainly marketed for day time use. Temazepam is more short acting and is marketed for insomnia, ie a hypnotic. The same goes for barbiturate sedative hypnotics. Longer acting ones are or were used for day time control of anxiety or seizures and shorter acting ones tended to be used more for insomnia.--Literaturegeek | T@1k? 10:03, 12 May 2008 (UTC)

The classification sedative-hypnotic was brought about in the late 1970's by the World Health Organisation and other health bureaucracies to replace the misleading term "minor tranquillisers" and "sleeping pills". Minor tranquillisers such as benzodiazepines and barbiturates and even alcohol at low to moderate doses induce anxiety relief and at higher doses induce sleep. The reality is the official medical definition says they are the same and should not be classed as different, so why does wikipedia have sedative and hypnotic in seperate pages against the official classification? I say merge the two pages as soon as possible. The fact that the world health organisation classes this group of substances/drugs as sedative/hypnotics should end the debate. So I am in favour of merging these two articles. :=)

See these two links. [1] and [2] --Literaturegeek | T@1k? 10:07, 12 May 2008 (UTC)

I've commented on the Talk page for Sedative in support of keeping these two articles separate. --Hordaland (talk) 20:56, 25 June 2008 (UTC)

unjustifiable risk[edit]

"A review of the literature regarding benzodiazepine hypnotic and Z drugs concluded that these drugs caused an unjustifiable risk to the individual and to public health, and lack evidence of long-term effectiveness due to tolerance. The risks include dependence, accidents, and other adverse effects. Gradual discontinuation of hypnotics leads to improved health without worsening of sleep."

The ref cited is no longer available, but even if it was, I do not think the general agreement with regards to regulatory agencies or physicians is to consider the use of hypnotic drugs as an unjustifiable risk to the patient or to public health. Many of these drugs from all classes are approved in markets world wide and specifically indicated for use in treating insomnia. They are also widely prescribed, suggesting that physicians also feel them to JUSTIFIED risks. http://www.drugs.com/top200_units.html Lunesta/ eszopiclone 5,714,000 RXs in 2010 in the USA Ambien/zolpidem 5,687,000 RXs in 2010 in the USA Seeing as they are in the top 50 most RX'd non-generics in the USA, it would follow that physicians are RX a lot of them and do not view them as excessively risky or ineffective. http://reference.medscape.com/drug/restoril-temazepam-342911#0 showing temazepam as indicated for insomnia. I think between the large quantity of RXed hypnotics and them being indicated for that use suggests that it has not in fact been "concluded that these drugs caused unjustifiable risk to the individual and to public health" and that this statement is not NPOV — Preceding unsigned comment added by Provomarsh (talkcontribs) 15:41, 6 April 2012 (UTC)

Agree
Crystal Clear action edit remove.png Removed meteor_sandwich_yum (talk) 04:50, 10 February 2014 (UTC)

Benzodiazepine section clean-up[edit]

The section on Benzodiazepines needs some work. It includes a very long paragraph that (quite frankly) rants about the dangers of benzodiazepine withdrawal without citing any sources until the very end. Insomnia is mentioned twice in the list of symptoms in one sentence, and the next enumerative sentence begins and ends with an assertion that potentially fatal seizures can occur. I know next to nothing about these drugs, but this paragraph definitely needs both additional citations and some basic clean-up. 71.58.209.95 (talk) 15:03, 28 September 2012 (UTC)

-- I agree.. I might just be tired, but this..: "It is a common misconception that drugs such as heroin, oxycodone, and other opiates are the most physically dangerous in withdrawal. Benzodiazepine addiction, is a far more dangerous dependency to have because unlike dependence to opiates and other drug classes, benzodiazepines and their counter-parts the z-drugs (Ambien for example) can be lethal in withdrawal" not only contains improper grammar, but from my medical knowledge, seems quite questionable, and should be backed by sources or removed. It's one thing to say benzodiazepines induce worse or more lethal withdrawals, and a VERY OTHER thing to say opiates and "other drug classes" are not lethal. Just WOW.. Somebody edit this.. I'm too tired to do it properly. — Preceding unsigned comment added by Mollyshelt (talkcontribs) 11:48, 4 June 2013 (UTC)
Agree with above two comments.
Began with copyediting, but felt Benzodiazepine#Insomnia was really the best bet. Still adapting it for this article.
Resolved: meteor_sandwich_yum (talk) 11:02, 6 February 2014 (UTC)

Adverse effects[edit]

The section about "adverse effects" is empty. This will give readers the impression that there is no issue about adverse effects.

The following study by Kripke et al. does suggest very substantial adverse effects, and this study has gotten a lot of attention in the media as well: "Hypnotics' association with mortality or cancer: a matched cohort study". I'll leave for others to decide what to do with this information here.Anythingyouwant (talk) 19:12, 30 March 2014 (UTC)

Noted. Meteor sandwich yum (talk) 00:47, 15 April 2014 (UTC)

Antihistamines[edit]

New-generation antihistamines don't have as many sedative or other side effects because they are more selective for H1 receptors and are less active at other receptors, not because they do not cross the blood-brain barrier. — Preceding unsigned comment added by 96.53.106.181 (talk) 22:31, 13 August 2014 (UTC)