Sedatives

introduction

The term sedative includes various drugs that have a calming or activity-reducing effect on the body. Tranquilizers are also called sedatives (singular: sedative, from the Latin "sedare" = to calm down), hypnotics (sleeping pills), narcotics or tranquilizers (tension relievers).

Application areas and effects

Sedatives are used to treat restlessness. This area of ​​application is very extensive, since restless states are the expression of many physical and / or psychological disorders. It also relieves anxiety through sedatives. Through the effect of the sedative, the conscious perception is dampened, which also creates a Distance from fears will be produced. However, this should not be done with the Anxiolysis, the targeted therapy of fear be confused. Furthermore, sedatives have a sleep-inducing effect. As a result, it occurs more often when taking sedatives fatigue up and falling asleep is easier.

In addition to the therapy of restlessness and anxiety, sedatives are also used in surgical medicine. Through the so-called Premedication Before the operation, the patient is relieved because the sedative is subjective stress for the patient is reduced. Sedatives (tranquilizers) are also used during the procedure to induce and maintain the anesthesia necessary. Sedatives are also used in intensive care units. There are many seriously ill patients who are artificially ventilated and who can only tolerate such therapy with sedatives. Another important area of ​​application for tranquilizers is Emergency medicine.

After accidents or traumatic experiences, it is often necessary to take the shock To provide sedatives to standing, restless and / or anxious patients in order to alleviate the restlessness and anxiety and to make initial medical care possible and to facilitate transport to a hospital. In summary, tranquilizers are used insomnia, inner restlessness, anxiety, anxiety and panic disorders and used to induce anesthesia.

Overview of the different groups of active ingredients

It is difficult to make a clear definition of the tranquilizers, as many drugs have a sedative effect. With many active ingredients, however, sedation is not the desired effectbut rather an undesirable effect or side effect. Before the different groups of active ingredients are briefly explained, a brief overview should be given of which drugs are considered to be sedative due to their sedative effect: Benzodiazepines, Antidepressants, Narcotics, Barbiturates, Neuroleptics, Opioids, Antihistamines and alpha-2 agonists have sedative effects and are therefore used as sedatives.

dosage

Sedatives should be dosed carefully and only taken in the amount prescribed by the doctor. Furthermore, a so-called occurs with many tranquilizers Ceiling effect (Saturation effect) if you take too high a dose. This effect describes that, despite the high dosage, the sedative does not work. This phenomenon is based on the fact that all receptors are already occupied with the active ingredient and so an increase in the active ingredient no longer has any effect, at most unwanted side effects, can be triggered. However, as part of long-term use of sedatives, a tolerance arise. Tolerance makes it necessary to take larger amounts of the sedative to produce the same reaction. In addition, sedatives can cause an addiction or Addiction trigger. Therefore, sedatives should not be stopped suddenly, but rather tapered by slowly reducing the dosage.

Side effects and drug interactions

The side effects of sedatives are diverse and each group of active ingredients has its own side effects. Therefore, the package insert of the drug should careful be studied and consulted with the doctor or pharmacist. In general, the side effects decrease after dose of the sedative taken and the duration of treatment. In addition, other factors such as the age of the patient and drug interactions play a role. The latter in particular plays a significant and possible role Drug interactions should be clarified with a doctor before taking sedatives and therefore avoided.

Sedatives cause physical and mental side effects. Common side effects on the psychological level are: Drowsiness, listlessness and tiredness. At the same time, the sleep structure is disturbed, especially that Phases of deep sleep become shortened. In addition, attention and the ability to concentrate are limited. Kick it Memory problems on. By slowing down is that too Responsiveness extended, which can have dramatic consequences in road traffic. Therefore, patients who take strong sedatives should be Not take part in road traffic alone.

The physical side effects are just as varied: disorders of appetite and the Weight gain, sexual disorders, a headache, Racing heart and emotional disorders. At the same time one occurs Relaxation of the muscles which together with the mental confusion with an unsteady gait and increased Risk of falling goes with what especially for old people Endanger the patient. An important and dangerous side effect of sedatives is the possible Respiratory and circulatory depressionwhich can occur especially in the event of an overdose. Especially with old patients or children there is a risk that the effect of the medication will be reversed (paradoxical reaction) and restlessness and fear reactions will occur more frequently.

More detailed information on different sedatives

Benzodiazepines

Benzodiazepines are the largest and most important group of sedatives. The benzodiazepines are divided into three groupswhich are based on their duration of action. Group 1 includes the short-acting Benzodiazepines (2 - 8 hours), such as midazolam (trade name Dormicum®) which a special high risk of habituation and addiction have and confusion or aggressions trigger. The drugs of this group are mainly used at sleep disorders and used for induction of anesthesia.

In group 2 are found medium length effective active ingredients (5 - 20 hours), which mainly contribute to their application Difficulty sleeping through the night Find. Belong to this group Lorazepam (Tavor®) or oxazepam (Adumbran®).

The benzodiazepines classified in group 3 have a duration of action of 20-100 hours and the breakdown of these active substances produces metabolites that continue to be effective. Clonazepam (Rivotril®), Diazepam (Valium®) or flurazepam (Dalmadorm®) are active ingredients of this group and have mainly one side effect high daytime sleepiness on. Furthermore, the ability to react is greatly reduced and the substances (above all Rohypnol®) are often misused in the Drug scene used or there is a dependency. To avoid addiction, tablet intake should be kept as short as possible and interrupted by breaks. In addition, after prolonged use the drug should slowly settled become.

Barbiturates

Barbiturates (methohexital, phenobarbital, thiopental) develop one stronger effect than benzodiazepines and therefore often still have in overdoses more fatal consequences than benzodiazepines. Since their effects cannot be canceled out directly, they cause you fatal respiratory and cardiac arrest. In addition, patients quickly develop one tolerance. Because of the numerous disadvantages of barbiturates, they will only for induction of anesthesia and epilepsy used.

Antidepressants

The medicinal possibilities of antidepressant therapy are enormously diverse and use numerous different modes of action. Many antidepressant agents work sedating and psychomotor dampening the patient. Especially those tricyclic antidepressantsAntidepressant drugs (TCA, especially amitriptyline, clomipramine, doxepin, trimipramine and Opipramol®) and selective serotonin reuptake inhibitors (SSRI, e.g. Citalopram, Sertraline) are used in addition to the therapy of depression also at Obsessive-compulsive illness or Anxiety disorders used. In the latter, however, they are dosed higher than in depression.

Neuroleptics and opioids

Neuroleptics are mainly used in the therapy of schizophrenia and psychotic disorders used, but also found in Personality disorders or Psychosis with restlessness, manic disorders or aggression Application. Neuroleptics are also used in anesthesia premedication. By inhibiting Histamine receptors they also have a sedating effect.

Opioids are the strongest pain relievers available with serious side effects. The therapeutic effects of opioids are that analgesia (Painkillers) and that Suppression of the cough stimulus (Antitussives). The side effects include addiction and Addiction, Respiratory depression, nausea and Vomitn, Constipation and a lower one Blood pressure. However, the sedating effect is also one of the side effects: Opioids sedate and dissolve sleep out. The patients can be awakened from the opioid-induced sleep, which is the case with barbiturates or benzodiazepines not possible is. The sedating effect of opioids is used by using highly effective opioids such as fentanyl, sufentanil or remifentanil as Narcotics begins.

Antihistamines

These drugs are used to treat allergic reactionslike that hay fever, used. Their mechanism of action inhibits the histamine receptors, which mediate a response that triggers wakefulness. Consequently, the inhibition of these histamine receptors results in significant sedation. This original side effect of antihistamines has been used as a desired effect and there are different ones Sleeping pills (Doxylamine, Diphenhydramine) or Anxiolytics (Hydroxyzine) based on an antihistamine. These drugs are available from pharmacies without a prescription, as they are generally only perceived as "light" sleeping pills.

Herbal tranquilizers

There are a number of herbal supplements that, in some studies, have a similar effect as with sufficient dosage Histamine receptor blockers exhibit. A well known herbal sedative is valerian, more precisely the essential oils that are extracted from the valerian root. Valerian has a calming effect and promotes sleep and sleep through. The effect does not occur immediately after the first ingestion, rather one ingestion is over at least two weeks necessary until the effects are noticeable. Especially with light ones sleep disorders or Anxiety can valerian help. It is often used in combination with other medicinal herbs. Also the Melissa leaves and their essential oil have a calming and anti-anxiety effect.

Have a similar effect too lavender and Passion flower. The medicinal herbs valerian, lemon balm, lavender and passion flower are often used together to relieve restlessness. Peppermint, i.e. tea or essential oil, also has a relaxing and calming effect. A beer (not excessive consumption) can also act as a sedative. The hops are an important ingredient in beer and promote sleep. The California poppies. It is used in herbal medicine primarily as a sleeping aid and sedative for mild mental stress.

Preoperative sedatives

The use of sedatives before an operation serves the patient fear and at the same time promote its responsiveness and cooperation. If the patient is anxious or agitated, a mild sedative can do the day before given during the operation so that the night before the operation is still calm. A sedative is then usually given before the operation to prevent the stress and should reduce anxiety. Premedication also makes it easier for the anesthetist to initiate the anesthesia and there are fewer Painkiller needed. Often an active ingredient from the benzodiazepine family, the so-called Dormicum®, used. This is a short-acting benzodiazepine that relaxes and calms the patient. Today benzodiazepines are used almost exclusively for oral premedication.