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Nonbenzodiazepine

1. Nonbenzodiazepine Classes and Pharmaceuticals: – Imidazopyridines (Alpidem, Necopidem, Saripidem, Zolpidem) – Pyrazolopyrimidines (Divaplon, Fasiplon, Indiplon, Lorediplon, Ocinaplon) – Cyclopyrrolones (Eszopiclone, Pagoclone, Pazinaclone, Suproclone, Suriclone) […]

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1. Nonbenzodiazepine Classes and Pharmaceuticals:
– Imidazopyridines (Alpidem, Necopidem, Saripidem, Zolpidem)
– Pyrazolopyrimidines (Divaplon, Fasiplon, Indiplon, Lorediplon, Ocinaplon)
– Cyclopyrrolones (Eszopiclone, Pagoclone, Pazinaclone, Suproclone, Suriclone)
– Nonbenzodiazepines bind to benzodiazepine site of receptor complex.
– Z-drugs (zopiclone, zolpidem, zaleplon) used for mild insomnia.
– Almost a third of Z-drug prescriptions for adults over 65.
– Long-term use not recommended due to tolerance and addiction risks.

2. Effectiveness and Safety of Nonbenzodiazepines:
– Limited evidence suggests slower tolerance development compared to benzodiazepines.
– Differences in tolerance and rebound effects among Z-drugs.
– Systematic review found Z-drugs’ effect sizes ranging from 0.03 to 0.63.
– Eszopiclone showed the most favorable profile among Z-drugs.
– Safety concerns include dependence, accidents, and adverse effects.
– Gradual discontinuation of hypnotics can lead to improved health without worsening sleep.

3. Side Effects and Safety Concerns:
– Z-drugs can cause pronounced amnesia and rare hallucinations.
– Fugue state risk with Z-drugs, leading to unconscious actions.
– Withdrawal-related anxiety possible with chronic nonbenzodiazepine use.
– Zaleplon may be safest for next-day sedation.
– Hypnotics, including nonbenzodiazepine Z-drugs, pose significant risks such as dependence and accidents.

4. Development and History of Nonbenzodiazepines:
– Z-drugs like zopiclone and zolpidem emerged in the late 1980s and early 1990s.
– Approval history of zaleplon, eszopiclone, and other Z-drugs.
– New compounds like alpidem and pagoclone offer non-sedating anxiolytic options.
– Nonbenzodiazepine drugs are more selective than older benzodiazepine anxiolytics.

5. Future Prospects and Research Directions:
– Further research needed to evaluate long-term effects of treatment and management strategies for elderly individuals with chronic insomnia.
– Development of new compounds presents promising alternatives for the treatment of anxiety and insomnia.
– Continued advancements in pharmacological approaches are essential for improving patient outcomes.
– Collaboration between researchers, clinicians, and regulatory bodies is crucial for optimizing insomnia management.

Nonbenzodiazepine (Wikipedia)

Nonbenzodiazepines (/ˌnɒnˌbɛnzdˈæzɪpn, -ˈ-/), sometimes referred to colloquially as Z-drugs (as many of their names begin with the letter "z"), are a class of psychoactive drugs that are benzodiazepine-like in uses, such as for treating insomnia and anxiety.

Chemical structure of the prototypical Z-drug zolpidem

Nonbenzodiazepine pharmacodynamics are similar in mechanism of action to benzodiazepine drugs, acting as GABAA receptor positive allosteric modulators of the benzodiazepine site, and therefore exhibit similar benefits, side effects, and risks. However, nonbenzodiazepines have dissimilar or entirely different chemical structures, so are unrelated to benzodiazepines on a molecular level.

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