#健康明星计划 #
Diazepam, clonazepam, escolam, alprazolam, lorazepam are commonly used in clinical sleeping pills, belonging to the benzodiazepine sedative hypnotics, can cause inhibition of different parts of the central nervous system, with the increase of the dosage, clinical manifestations can be mildly sedated to hypnotic or even comatose. Diazepam mechanism of action is more complex, it is currently believed that after interacting with specific nerve cell membrane receptors, it can strengthen and promote the nerve conduction function of the main inhibitory neurotransmitter γ-aminobutyric acid (GABA) in the brain, mainly in various parts of the central nervous system, play a prominent pre- and post-synaptic inhibitory effect, not only has a sedative and hypnotic effect, but also can be anti-anxiety, anti-convulsions, anti-epileptic, relax skeletal muscle, under the therapeutic dose, it can interfere with the establishment of memory pathways and affect the memory of recent events.
Diazepam is mainly used for the treatment of insomnia, anxiety disorders and depression with anxiety, phobias, tension headaches, idiopathic tremors and the like. Clonazepam is mainly used to control various types of seizures, and has a good effect on absence small seizures, myoclonus seizures, motor inability to have seizures, and infantile spasms. In addition, clonazepam also has an anti-panic effect, the sedative hypnotic effect is relatively weak, suitable for panic disorders, less for insomnia. Eszolam is mainly used for insomnia, anxiety, nervousness and fear, but can also be used for anti-epileptic and anticonvulsant. Alprazolam is mainly used for anxiolysis, can be used as an adjunct to anxiety and depression, and can also be used for anti-panic and sedative hypnosis. Lorazepam is mainly used for anxiolytic, the treatment of anxiety disorders or short-term relief of anxiety symptoms, including anxiety accompanied by mental depression, but also for sedative hypnosis, the treatment of anxiety or insomnia in temporary, environmental stress states, and also for the treatment of tension headaches.
Diazepam is used for sedation, 2.5-5 mg at a time, 3 times a day. For hypnosis, 5-10 mg at a time, taken before bedtime. For anxiolytic use, 2.5-10 mg at a time, 2-4 times a day. For antiepileptic and anticonvulsant, 2.5-10 mg at a time, 2-4 times a day. For acute alcohol withdrawal, 10 mg once a day, 3-4 times a day, and then reduced to 5 mg once a day, 3-4 times a day. Older adults should use the smallest effective dose, in slow increments, to reduce dizziness, ataxia, and excessive sedation. The initial oral dose is 2-2.5 mg once, 1-2 times a day, in gradual increments.
Clonazepam is used for epilepsy, starting at 0.5 mg at a time and increasing by 0.5-1 mg 3 times a day until seizures are controlled or adverse reactions occur. The dosage should be individualized, and the maximum amount for adults should not exceed 20 mg a day. For panic disorder, the starting dose is 0.25 mg once, 2 times a day, and the recommended therapeutic dose is 1 mg per day. When discontinuing the drug, the dose should be gradually reduced to 0.125 mg once, twice a day, and the drug should be discontinued after 3 days. For insomnia, take 2 mg at a time at bedtime.
Eszolam is used for sedation at a dose of 1-2 mg at a time, 3 times a day. For insomnia and anxiolytic, the dose is 1-2 mg, taken 1 time before bedtime. For antiepileptic and anticonvulsant, the dose is 2-4 mg at a time, 3 times a day. The elderly or the infirm can start with 0.5 mg and increase the amount slowly as appropriate.
Alprazolam is used for sedative hypnosis at a dose of 0.4-0.8 mg, taken once at bedtime. For anxiolytic use, the starting dose is 0.4-1.2 mg once, 2 times a day, the dosage is increased as needed, the maximum limit is 4 mg a day. For anti-fear, the dose is 0.4 mg at a time, 3 times a day, gradually increasing the dose when necessary, with a maximum of 10 mg a day. Elderly and frail patients can start with 0.2 mg and gradually increase to the maximum tolerated dose.
Lorazepam is used for anxiolytic, 0.5-1 mg at a time, 2-3 times a day. For sedative hypnosis, take 2-4 mg before bedtime. The elderly and the infirm should reduce the dose.
Zopiclone, dexzopiclone, and zolpidem are new sleeping pills commonly used in clinical practice. Zopiclone is a third-generation hypnotic cyclopyrrolidone with pharmacological effects similar to benzodiazepines, acting at different binding sites (A-1 subtype receptors) at benzodiazepine sites in γ-aminobutyric acid (GABA) receptor/chloride channel complex, with sedative, hypnotic, anxiolytic, muscle relaxation, and anticonvulsant effects. Zopiclone is a quick-acting hypnotic, rapidly effective, stronger than benzodiazepines, suitable for insomnia caused by various causes, can prolong sleep time, improve sleep quality, reduce the number of night awakenings and early awakenings, especially for patients who cannot tolerate residual effects the next day.
Dexzopiclone is also a commonly used clinical sedative hypnotic, belongs to the cyclopyrrolidone compound, is a dextrochanic single isomer of zopiclone, the affinity for central benzodiazepine receptors is 50 times stronger than zopiclone, its selective action on benzodiazepine receptor-coupled γ-aminobutyric acid receptor A1 and A2 subtypes, more selective to A1 subtype receptors, manifested as sedation, hypnosis, anxiolytic, muscle relaxing and anticonvulsant effects, suitable for various types of insomnia.
Zolpidem is a novel non-benzodiazepine sleeping pill, mainly by agitating benzodiazepine receptors, selectively acting on the A1 subtype receptors of γ-aminobutyric acid, only sedative and hypnotic effects, and no anticonvulsants, muscle relaxation and anxiolytic effects, suitable for short-term insomnia patients.
Zopiclone is recommended to take 7.5 mg before going to bed in adults, the elderly and weak people take Zopiclone, which can damage motor and cognitive ability, patients with hepatic insufficiency take Zopiclone, easy to cause accumulation, increase the risk of adverse reactions, the recommended dosage for the above population is 3.75 mg, renal insufficiency does not need to adjust the dose.
The recommended starting dose for adults with dexzopiclone is 2 mg orally before going to sleep, which can be gradually increased to 3 mg according to clinical needs, the recommended starting dose is 1 mg before bedtime for elderly patients with difficulty falling asleep, which can be gradually increased to 2 mg, and the starting dose is 2 mg before falling asleep in elderly patients who are easy to wake. The initial dose should be reduced to 1 mg in severely impaired liver function. Avoid taking dexzopiclone immediately after a high-fat diet.
Zolpidem is taken orally 10 mg every night before bedtime, and in patients with liver and kidney function impairment, start at 5 mg before bedtime, and the dosage does not exceed 20 mg per day. The starting dose for the elderly is 5 mg, taken orally at bedtime, not exceeding 10 mg per night. If adverse reactions such as gait instability and clumsiness of hands and feet occur during treatment (especially in the elderly), the dosage should be checked in time. Zolpidem works quickly and should always be taken before bedtime, or on an empty stomach to make it work quickly.