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significant memory impairment, abnormal thinking or behavior, confusion, anxiety, and depression. Zaleplon (Sonata) is a short-acting, nonbenzodiazepine γ-aminobutyric acid A (GABA A ) agonist hypnotic, which has no active metabolites. It has proven to be effective in the treatment of patients with sleep disorders by presenting less residual central nervous system or ‘‘hangover’’ effects, which are seen in patients using other drugs of the benzodiazepine group. 5 , 6 Although not structurally related to the benzodiazepines, zaleplon has many pharmacological

approved by the FDA in December 2004. 53 54 Zaleplon (Sonata, Starnoc) Zaleplon (Sonata, Starnoc) is a short-acting, nonben-zodiazepine sedative-hypnotic that also possesses anticonvulsant, anxiolytic, hypnotic, and myorelaxant properties. Zaleplon was FDA-approved in 1999 and has a faster onset of action and a shorter terminal elimination half-life than zolpidem. Zaleplon is available in 5 mg and 10 mg capsules and the usual dosing range is from 5 mg to 20 mg. 55 In Japanese adults (and possibly other Asian populations), the maximum

more traditional benzodiazepines. These newer agents include zolpidem (Ambien) and Zaleplon (Sonata), having relatively fast onset and short durations, and eszopiclone (Lunesta) having a slower onset and longer duration. Dental Implications for Patients Medicated with Sedative-Anxiolytics Drug tolerance and dependence are the principal concerns for the dentist when managing patients taking sedatives chronically. Common sense dictates caution when administering sedation or general anesthesia due to the potential for enhanced CNS

delay the elimination of the drug and prolong patient recovery. If large amounts of these sedatives are required for effective sedation, the dentist must carefully reconsider normal discharge criteria and patient instructions when patients are taking any medications that inhibit CYP3A ( Table 3 ). These issues are also a concern for newer nonbenzodiazepine sedatives, zolpidem (Ambien), and zaleplon (Sonata), which also are eliminated by CYP3A4. Promethazine (Phenergan), prochlorperazine (Compazine), and droperidol (Inapsine) are used as antiemetics and as

Increments should be halved when managing not only geriatric patients but those having significant medical compromise as well. In recent years novel agents resembling benzodiazepines have been introduced for managing insomnia. These so-called “Z compounds” include zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). Their molecular structures differ from benzodiazepines and can be distinguished chemically as nonbenzodiazepines for marketing—a strategy to capitalize on negative views regarding benzodiazepines. They act as agonists at benzodiazepine

induced by ketamine’s propensity to increase salivary secretions should be considered when using this sedative in oral regimens. In addition, some settings and regions may prohibit its use by personnel not trained in the administration and management of deep sedation or general anesthesia. Zolpidem Zolpidem is a short-acting “nonbenzodiazepine” hypnotic drug colloquially referred to as a member of the “Z-drug” family along with zopiclone and zaleplon. Binding still occurs on the GABA A receptor similarly to benzodiazepines; however