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Non-benzodiazepines

Summary

When sleep medicines are used every night for more than a few weeks, they may lose their effectiveness to help you sleep. This is known as "tolerance". Sleep medicines should, in most cases, be used only for short periods of time, such as one or two days and generally no longer than one or two weeks. These drugs are best used for people dealing with a traumatic event, such as a death in the family or job upheaval. People who've had trouble sleeping for a couple of weeks. Best for short term use.

The major Brand names for Non-benzodiazepines include: Ambien, Sonata, and Lunesta. Lunesta, along with other "Z Drugs" including Ambien and Sonata are the most commonly prescribed sedative hypnotics in the USA.

Advantages of non-benzodiazepine sleeping aids:

Non-benzodiazepine hypnotics like Ambien, Sonata, and Lunesta have advantages over previous generations of sleep medication. These include such things as:

  • a relatively short half life so one does not wake up with a “hangover” the following day

  • having little effect on sleep staging, allowing the individual to obtain approximately the same amount of time in each stage of sleep as one would without the medications

  • less likely to cause addiction, withdrawal, or tolerance relative to older sleeping medications.

However, it should be kept in mind that these medications will not address any underlying medical problems causing the insomnia, such as sleep-related breathing disorders (sleep apnea), restless legs syndrome, and of course, chronic pain. Therefore, they should only be used in conjunction with other treatments that are focusing on the primary medical problem.

How they work

Attaches to certain receptors on brain cells that trigger sleepiness.

Side Effects & Risks

Some risk of psychological dependency. Can cause dangerous behavior in some, such as driving while sleeping. Suppresses rapid eye movement (REM) sleep.

News: Ambien. Lunesta, Other "New-Generation" Sleep Aids Linked to Bizarre Behavior

New generation sleeping pills, like Lunesta and Ambien, may also cause serious adverse reactions as older sleep aids. While older pills are much more likely to cause daytime sedation, addiction and withdrawal symptoms, drug classified as nonbenzodiazepines (NBZs), including Lunesta and Ambien, seem just as likely to cause amnesia and erratic behavior.

But, it appears that NBZs have not eliminated all of the problems associated with sleeping pills. According to a report in The Wall Street Journal, and analysis of adverse-event reports filed with the World Health Organization suggests that some side effects of this generation of sleep medications may be as bad as - and even worse than the older generation, including Halcion, which was banned in some countries.

People under the influence of these drugs have gone on eating binges, driven their cars and engaged in other activities that they later can't remember. The Wall Street Journal relates one story of a woman who painted her front door in her sleep, and in some cases people have had serious car accidents and even set fore to their homes while in the seemingly hypnotic state sometimes caused by the drugs.

Such reports prompted the Food and Drug Administration (FDA) last year to require that Ambien, Lunesta and other similar drugs carry strong warnings. But these sleep aids are still wildly popular, and the number of prescriptions written for them grew by 10% last year.       

Ambien CR

Ambien CR (zolpidem tartrate extended release) is different from Ambien (zolpidem tartrate) in that the medication is formulated in a 2 layer tablet. The first layer of the Ambien CR tablet dissolves quickly to help people fall asleep, while the second layer dissolves slowly over the night to help people stay asleep (something Ambien has not demonstrated in trials). The action of both immediate and continuous release with Ambien CR allows for increased effectiveness over the night (since blood levels are more stable 3 to 6 hours after taking medication) and is proven to be more effective than traditional Ambien in quality of sleep. Ambien Cr and Ambien have the same active ingredient so the safety and tolerability profiles are similar. Event tough Ambien CR helps maintain sleep throughout the middle of the night it does not increase the risk of "hangover" effects (same as regular Ambien). A recent long term study found effectiveness over 6 months, improved morning concentration and daytime function, and no risk of abuse with Ambien CR.

Common Side Effects

In controlled clinical trails of Ambien CR, the most commonly observed adverse effects were headache, somnolence (sleepiness), and dizziness.

Lunesta

Eszopiclone, marketed by Sepracore under the brand name Lunesta, ia a non-benzodiazepine hypnotic agent (a sedative) used as a treatment for insomnia. Eszopiclone is the active stereoisomer of zopiclone, and belongs to the class of drugs known as cyclopyrrones.

Eszopiclone is a short acting non-benzodiazepine sedative hypnotic. It has been shown to be a safe and effective short term treatment in the elderly and safe in younger adults for 6-12 months. All clinical trails of eszopiclone published so far are industry funded by the pharmaceutical manufacturer of eszopiclone, Sepracor.

Eszopiclone is prescribed for the management of insomnia. Sedative hypnotic agents including eszopiclone are among the most studied drugs to treat insomnia.

Common Side Effects

  • unpleasant bitter or metallic taste/smell

  • headaches

  • cold like symptoms

  • pain

  • daytime drowsiness

  • lightheadedness

  • dizziness

  • loss of coordination

  • upset stomach

  • vomiting

  • decreased sexual desire

  • painful menstruation

  • breast enlargement in males

  • heartburn

  • unusual dreams

If a person does not sleep immediately after taking their Lunesta or if they get up shortly after taking their medication that may experience dizziness, lightheadedness, hallucinations, as well as experience problems with coordination and memory.

Increased Risk of Depression

It has been claimed that insomnia causes depression and hypothesized that insomnia medications may help to treat depression. However, an analysis of data of clinical trials submitted tot he FDA concerning the drugs zolpidem, zaleplon and eszopiclone found that these sedative hypnotic drugs more than doubled the risks of developing depression compared to those taking placebo pills. Hypnotic drugs therefore may be contrindicated in patients suffering from or at risk of depression. Hypnotics were found to be more likely to cause depression than to help it. Studies have found that long term users of sedative hypnotic drugs have a markedly raised suicide risk as well as an overall increased mortality risk.

If a person has taken eszopiclone for longer than 1-2 weeks they should not stop taking the medication abruptly and should consult their doctor. Usually doctors will direct a slow reduction in dosage to minimize withdrawl symptoms.       

Sonata

Prices

Sleeping Pill Prices found online at Drugstore.com...

Drug Quantity Price
Ambien 10 mg. tablets 90 $391.02
Ambein CR 12.5 mg tablets 90 319.97
Lunesta 1 mg. tablets 30 150.21
Lunesta 2 mg. tablets 30 153.82
Lunesta 3 mg. tablets 30 153.83

 

Source: SleepWeb (Marketdata Enterprises, Inc.) research, FDA

*page last updated  05/12/2008

 

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