Source: Center for Drug Evaluation
Adult Among them, 10-15% of them meet the diagnostic criteria for insomnia. Non-benzodiazepines (non-BZDs) such as eszopiclone, zopiclone, zaleplon, and zolpidem have gradually replaced benzodiazepines (BZDs). It has become a commonly used hypnotic drug in clinical practice. Mastering the difference between the four drugs is the basis for rational drug use. I. Elimination half-lifeThe shorter the half-life, the shorter the time to maintain sleep, and the lower the residual effect the next day. 1. Zaleplonhalf-life of 1 hour, 3 hours after administration, 87% of the drug has been eliminated from the body, does not prolong the total sleep time, and does not reduce the number of awakenings. Daytime sleepiness generally does not occur. 2. ZopicloneHalf-life of 5 hours and the longest sleep duration, The risk of next-day residual effects is greater. 2. Zolpidemhalf-life 0.7~3.5 hours, there are larger individuals difference. Taking the same dose of zolpidem, the peak concentration (Cmax) and bioavailability (AUC) of females increased by 40% compared with males, the total clearance rate decreased by 30% compared with males, and the elimination half-life was also prolonged. Female patients should choose a lower initial dose. II. Adverse reactions1. Zaleplon strong>It can be secreted into breast milk and should be avoided by breastfeeding women. 2. ZolpidemHigh incidence of sleepwalking (sleepwalking driving, cooking, talking on the phone, etc.) . Sleepwalking can appear not only during the first dose of medication, but also suddenly after a period of medication. If sleepwalking occurs, zolpidem should be discontinued. 3. Zopiclone and eszopiclonecan be excreted through saliva, and the most common adverse reactions are span>A bitter or metallic taste in the mouth. Third, the difference between eszopiclone and zopiclonezopiclone is a racemate. Zopiclone=S-zopiclone (50%)+R-zopiclone (50%). 1. ToxicityS-zopiclone (eszopiclone) clone) is one-fifth as toxic as R-zopiclone. Therefore,eszopiclone is less toxic than zopiclone. 2. EfficacyEszopiclone (S-zopiclone) has faster absorption and longer half-life. However, zopiclone contains 50% eszopiclone, so there is no difference in onset and maintenance time between eszopiclone and zopiclone. 4. How to choose? 1.Zaleplon< span>Short half-life (1 hour), fast elimination, and small residual effect the next day. If you wake up at night and cannot go back to sleep, and is ≥4 hours from the expected time to wake up, Zalep can be taken Long. 2.ZolpidemThe half-life varies greatly between individuals ( 0.7~3.5h)patients with short total sleep time (<6.5h), zopiclone or dexamethasone can be preferred. Zopiclone. V. Dosage< span>1. DosageStart with a small dose, and when an effective dose is reached, do not easily reduce or increase the dose. 2. Dosing timeTake zopiclone, eszopiclone and zapiclone 5-10 minutes before bedtime Pron. Take zolpidem immediately before bedtime (theoretically reduces the risk of sleepwalking events). 3. Frequency of useAlthough non-benzodiazepine hypnotics have a shorter half-life, research results show that < /span>Take the medicine 3 to 5 days a week, you can meet the sleep requirements, and you do not need to take the medicine every night. 4. Duration of medicationContinuous use for a maximum of 4 weeks, if more than 4 weeks, clinical evaluation is required . Patients who take the drug for a long time should not stop the drug suddenly, otherwise, withdrawal symptoms may occur. Special reminder:Do not drink alcohol before and after use!
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