Document Detail

In the Zzz zone: the effects of Z-drugs on human performance and driving.
MedLine Citation:
PMID:  23456542     Owner:  NLM     Status:  MEDLINE    
Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.
Naren Gunja
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  9     ISSN:  1937-6995     ISO Abbreviation:  J Med Toxicol     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-20     Completed Date:  2013-12-17     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  163-71     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Acetamides / adverse effects*,  pharmacokinetics
Automobile Driving
Azabicyclo Compounds / adverse effects*,  pharmacokinetics
GABA-A Receptor Agonists / adverse effects*,  pharmacokinetics
Hypnotics and Sedatives / adverse effects*,  pharmacokinetics
Piperazines / adverse effects*,  pharmacokinetics
Psychomotor Disorders / chemically induced*
Psychomotor Performance / drug effects*
Pyridines / adverse effects*,  pharmacokinetics
Pyrimidines / adverse effects*,  pharmacokinetics
Reg. No./Substance:
0/Acetamides; 0/Azabicyclo Compounds; 0/GABA-A Receptor Agonists; 0/Hypnotics and Sedatives; 0/Piperazines; 0/Pyridines; 0/Pyrimidines; 151319-34-5/zaleplon; 43200-80-2/zopiclone; 7K383OQI23/zolpidem

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Validity of somatic symptoms as indicators of depression in pregnancy.
Next Document:  Spectral domain optical coherence tomography findings in bilateral peripheral cone dystrophy.