Overcoming Obstacles: Therapeutic Success Despite External Barriers

摘要: Currently prescribed hypnotics (i.e., benzodiazepines and benzodiazepine-like compounds) are commonly categorized according to pharmacokinetic profile, which is primarily distinguished by long, intermediate, or short elimination half-life. Hypnotics with a long half-life (flurazepam quazepam) maintain efficacy over prolonged periods of nightly use their discontinuation does not usually result in rebound insomnia, but they have the major drawback causing unwanted potent daytime sedative effects. Use intermediate (estazolam, flunitrazepam, lormetazepam, nitrazepam, temazepam) associated carryover effects moderate intensity varying degrees tolerance insomnia. Rapidly eliminated benzodiazepine (brotizolam, midazolam, triazolam) nonbenzodiazepine (zaleplon, zolpidem, zopiclone) practically devoid effects, making them appropriate for majority cases generally relatively rapid development rather frequent occurrence insomnia upon discontinuation. Contrary previous beliefs, vary considerably among rapidly hypnotics: intense triazolam slight midazolam while triazolam, variable quite mild zolpidem. For brotizolam, zaleplon, zopiclone, existing relevant research findings still inconclusive; brotizolam however, appear marked potential and/or seem be case zaleplon. (Primary Care Companion J Clin Psychiatry 2002;4[suppl 1]:27–32)