TREATMENTS FOR INSOMNIA HYPNOTICS

Transcription

1 TREATMENTS FOR INSOMNIA HYPNOTICS Drugs Brand Forms available available* name(s) Tablets Capsules Liquid Injection Non-benzodiazepine hypnotics Zopiclone Zimovane Promethazine Phenergan Sominex Chloral Betaine Chloral Welldorm Somnwell Diphenhydramine Nytol Benzodiazepine hypnotics Temazepam Nitrazepam Mogadon Somnite Remnos * Other medicines are used for the treatment of insomnia; however this is a list of the medicines that are most often used within Cambridgeshire and Peterborough NHS Foundation Trust. What are they used for? Hypnotics make you sleepy and are used in the short-term treatment of insomnia (or difficulty in getting to sleep or staying asleep). The benzodiazepines are also 'calmers'. They help to calm you down and can make you sleepy, particularly if you are also anxious. There are alternative ways of beating insomnia that do not require medicines. A leaflet about these alternative methods, called Practical steps to beat Insomnia is available from the Trust s website. How do these medicines work? The medicines listed above have different ways of working. The benzodiazepines work with a neurotransmitter (a chemical in the brain) called GABA to make its action more powerful; this helps to calm down the brain and helps you to sleep. Zopiclone acts in a similar way. Page 1 of 6

2 How should I take it? Tablets: Tablets should be swallowed whole with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. The tablets should not be chewed. Liquid (where available): The liquid may be measured with a medicine spoon or oral syringe your pharmacist can supply one if needed, and show you how to use it to measure the correct amount. Shake the bottle of medicine to mix it well before you pour the dose. When should I take it? Take the dose as directed on the medicine label. This will usually be just before you intend to go to sleep. How long will the medicine take to work? They should start to work about half an hour to an hour or so after you take them. If they do not work or make you too sleepy the next morning, your doctor may need to adjust the dose to suit you. How long will I need to keep taking the medicine for? This should be discussed with your doctor as people respond differently. They are safe drugs if used sensibly. They should be taken in as low a dose as possible for the shortest time possible. This would ideally be for no longer than about one month to help you get over your problems. If you need to take them for longer you should discuss this regularly with your doctor. Taking them only when required or every few days or on alternate nights can be a useful way to use these drugs safely. Are these medicines addictive? Due to the effects that these drugs have on the brain they can sometimes produce a type of dependence (or addiction) in some people if taken regularly every night for more than about four to six weeks. Dependence or addiction means that you cannot manage without them; if you stop them you get 'withdrawal' symptoms. These withdrawal symptoms could at worst include anxiety, tension, poor concentration, difficulty in sleeping ('rebound insomnia'), palpitations and sweating. This is more likely with higher doses and after taking the drugs for a long time. The withdrawal symptoms may occur several days after stopping the drug. They may last for a few weeks but could go on for longer. If you have taken a hypnotic for a long period of time your doctor may need to reduce your dose gradually to minimise withdrawal effects. It is also true to say that some people suffer no withdrawal symptoms at all when they stop, even if they have been taking hypnotics for a while. You should therefore make sure that you discuss your particular circumstances with your doctor. Page 2 of 6

3 Can I stop taking my medicine suddenly? It is best not to stop suddenly if you have been taking a hypnotic regularly every day for more than about four to six weeks. If you do, you may get some withdrawal effects as mentioned above. What should I do if I forget to take a dose? Take the dose as soon as you remember. If you take it too late at night you may feel more drowsy the next morning. What sort of side-effects might occur? The following table lists the most common and important side-effects of hypnotics, with some information about what may help. It is not a complete list of the rarer side-effects. Ask your doctor or pharmacist if you would like more information. Even common side-effects are not experienced by everyone, so don t assume you will definitely get them. If you develop any symptoms that worry you, mention them to your doctor, nurse or pharmacist. Side-effect What happens What to do about it Common Drowsiness Dizziness Less common Ataxia Rare Change in behaviour Headache Confusion You feel sleepy or sluggish the next morning. It can last for a few hours after taking your dose, or longer. Feeling light-headed and faint. Being unsteady on your feet. Feeling excitable. You may be talkative, unfriendly or disinhibited. Your head is pounding and painful. Your mind is all mixed up or confused. Don't drive or use machinery. Discuss with your doctor it could be that an adjustment to the dose or trying a different drug could be of benefit. This may be worse at the start of treatment, or after a dose increase, but often wears off after a few days. Take your time when standing up after sitting or lying down. If you feel dizzy, don't drive. Discuss with your doctor when you next see him or her. Discuss this with your doctor. He or she may want to adjust your drug or dose. If it only happens occasionally, you can take a painkiller. Ask your pharmacist for advice on which painkiller is safe with your other medications. If the headaches continue, or happen often, tell your doctor. Discuss with your doctor when you next see him or her. He or she may want to adjust your drug or dose. Page 3 of 6

4 Hypotension Amnesia A low blood pressure - this can make you feel dizzy, especially when you stand up. Loss of short-term memory or difficulty in remembering. This may be worse at the start of treatment, or after a dose increase, but often wears off after a few days. Take your time when standing up after sitting or lying down. If you feel dizzy, don't drive. It is not dangerous. Discuss with your doctor if you are worried. Rashes Blotches seen anywhere. Stop taking the drug and see your doctor now. Miscellaneous side-effects Stomach upset (with zopiclone and chloral betaine) Wheeziness (with chloral betaine and promethazine) Bitter or metallic taste (with zopiclone) Anticholinergic side-effects (with promethazine) Photosensitivity (with promethazine) Palpitations (with promethazine) This includes feeling sick, stomach pains and getting diarrhoea (the runs). When you find it difficult to breathe, and your chest feels tight. Your mouth tastes as if has had metal or something bitter in it. Dry mouth, blurred vision, difficulty in passing urine, constipation. Going blotchy in the sun. A fast heart beat. If you feel like this for more than a week after starting chloral, tell your doctor. This may happen if you have asthma. Do not take any more tablets and contact your doctor now. This should wear off after a few weeks. If it does not, mention this to your doctor next time you meet. A change in dose or drug may help. These are usually mild and should wear off after a few weeks. If not, contact your doctor. This is uncommon. If it occurs, avoid direct sunlight or sun-lamps. Use a high factor sun block cream. It is rare, but if it happens, stop taking the drug and contact your doctor about it. Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission ( Will the medicine make me drowsy? Hypnotics are used to help you sleep and therefore should make you feel drowsy. You may however still feel drowsy the next morning so you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as it may affect your reaction times, even if you feel OK. Will this medicine cause me to put on weight? It is not thought that the majority of these medicines cause changes in weight. If you do start to have problems with your weight, however, tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice. Will this medicine affect my sex life? The hypnotics do not have any significant effects on sexual function, unless of course you are too sleepy or have already gone to sleep. Page 4 of 6

5 Can I drink alcohol while I am taking sleeping tablets? You should avoid alcohol while taking these drugs as it may make you feel more sleepy. This is particularly important if you need to drive or operate machinery and you must seek advice on this. The hypnotics can also increase the effects of alcohol. If you take alcohol the next day (e.g. lunchtime) this can also make you feel more drowsy than you would expect. Are there any foods or drinks that I should avoid? You should have no problems with any food or drink other than alcohol (see above). Will a hypnotic affect my other medication? These medicines can interact with other sleeping drugs and some antidepressants by increasing their sedative effects. This does not necessarily mean the drugs can not be used together, just that you need to follow your doctor s instructions very carefully. Make sure your doctor knows about all the medicines you are taking. Some other medicines you may take from your doctor or buy for yourself e.g. some antihistamines (for hay fever) can make you drowsy. Combined with your hypnotic this could make you even more drowsy. You should tell your doctor before starting or stopping these or any other drugs, and ask your pharmacist before buying any medicines. Chloral betaine can interact with some anticoagulants like warfarin. Always read the information that comes with any tablets you take before taking your sleeping tablet, and refer to your pharmacist if it says that it should not be taken with a sleeping tablet. If I am taking a contraceptive pill, will this be affected? It is not thought that the contraceptive pill is affected by any of these drugs. What if I want to start a family or discover I m pregnant? If possible, the best option is to plan in advance and discuss with your doctor. Taking some medicines during pregnancy may affect your baby, but there may also be a risk in not taking medication you could become ill again, which may affect your ability to cope with pregnancy and looking after a baby. Your doctor can discuss your individual circumstances, and advise on which medicines are thought to carry least risk. If you have just discovered you are pregnant, don t suddenly stop your medication. Seek advice from your doctor within the next few days if possible. He or she may want to refer you on to someone with more specialist knowledge of your medicine. Please see the separate sheet Mental health medications in pregnancy for more information. Will I need a blood test? You will not need to have a blood test to check on your hypnotic. Can sleeping tablets affect my ability to drive? These drugs can reduce your ability to carry out skilled tasks, and they can affect your reaction times. These effects can carry over to the next day, even though Page 5 of 6

6 you feel OK. Until the effects wear off, or you know how the drug affects you, do not drive or operate machinery. Please see the separate sheet Driving, mental health and medication for more information. Page 6 of 6