Sedative

A sedative or tranquilizer (or tranquilliser, see American and British English spelling differences) is a substance that induces sedation by reducing irritability or excitement.

At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Doses of sedatives such as benzodiazepines, when used as a hypnotic to induce sleep, tend to be higher than amounts used to relieve anxiety, whereas only low doses are needed to provide a peaceful and calming sedative effect.

Sedatives can be misused to produce an overly-calming effect (alcohol being the classic and most common sedating drug). In the event of an overdose or if combined with another sedative, many of these drugs can cause unconsciousness (see hypnotic) and even death.

Terminology

There is some overlap between the terms "sedative" and "hypnotic". The terms describe distinct effects, but medications that cause one of these effects often also cause the other.

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:

• Anxiolytic refers specifically to the effect upon anxiety. (However, some benzodiazepines can be all three: sedatives, hypnotics, and anxiolytics).
• Tranquilizer can refer to anxiolytics or antipsychotics.
• Soporific and sleeping pill are near-synonyms for hypnotics.

Types of sedatives

• Barbiturates
  • amobarbital (Amytal)
  • pentobarbital (Nembutal)
  • secobarbital (Seconal)
  • phenobarbital (Luminal)

• Benzodiazepines (trade names)
  • clonazepam (Klonopin N.America; Rivotril Europe, Asia )
  • 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)
  • alprazolam (Xanax)

• Nonbenzodiazepine "Z-drugs" sedatives
  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • zopiclone (Imovane, Zimovane)

• Antihistamines
  • diphenhydramine
  • dimenhydrinate
  • doxylamine
  • mirtazapine
  • promethazine

• Herbal sedatives
  • Duboisia hopwoodii
  • Prostanthera striatiflora
  • catnip
  • kava (Piper methysticum)
  • valerian
  • cannabis
  • passiflora spp.(passiflora incarnata)
  • Validol

• Other
  • chloral hydrate
  • alcohol
  • trazodone
  • opiates and opioids
  • glutethimide
  • GHB

Therapeutic use

Doctors 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

Some sedatives can cause physiological and psychological dependence when taken regularly over a period of time, even at therapeutic doses. 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 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

Main article: Drug overdose

Further information: Combined drug intoxication

See also: Benzodiazepine overdose and Barbiturate overdose

Many sedatives can be abused, 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. Some heroin 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 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.

There are also serious paradoxical 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 of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.

The term "chemical cosh"

The term "chemical cosh" is sometimes used popularly for a strong sedative, particularly for:

• widespread dispensation of antipsychotic drugs in residential care to make people with dementia easier to manage.
• use of ritalin to calm children with attention deficit hyperactivity disorder.
  • See also Antipsychotic controversy

Dangers of combining sedatives and alcohol

Further information: Combined Drug Intoxication

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 and this combination can prove fatal.

Sedatives and amnesia

Sedatives 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, typically via IV drip, are more likely to experience such side effects.

Sedatives and crime

Sedatives — most commonly alcohol but also GHB, Flunitrazepam (Rohypnol), and to a lesser extent, temazepam (Restoril), and midazolam (Versed) — have been sometimes reported for their use as date rape drugs (also called a Mickey) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people.

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^{[citation needed]}, 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.

See also

• Hypnotic
• Antidepressants
• Benzodiazepine withdrawal syndrome
• Tranquilizer
• Tranquilizer gun
• Diphenhydramine citrate

Further reading

• Tone, Andrea. The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers (Basic Books, 2009) 288 pp.; ISBN 978-0-465-08658-0 excerpty and text search