- Last edited on May 5, 2021
Non-Benzodiazepine Hypnotics ("Z-drugs")
Primer
Non-Benzodiazepine Hypnotics (“Z-drugs”) include eszopiclone, zolpidem, and zopiclone.
Indications
- Treatment with Z-drugs usually should not exceed 7 to 10 consecutive days.
- If there is use for more than 2 to 3 consecutive weeks, the clinician should do a complete re-evaluation of the patient and reassess any underlying medical or psychiatric disorders.
Mechanism of Action
- Bind to GABA receptors that are distinct from those affected by benzodiazepines
Advantages
- Compared to benzodiazepines, there is minimal anticonvulsant, respiratory depressant, and muscle relaxant effects
Adverse Events
Addiction
- These drugs still have addictive potential
- Some studies suggest that withdrawal and tolerance can occur after a longer period of use (2 to 3 months) relative to benzodiazepines (4 weeks)
Parasomnias
See main article: Non-REM Parasomnias (Non-REM Sleep Arousal Disorders)
- “Z drugs” may cause non-REM parasomnias (e.g. - sleep walking) and should be avoided in patients who have parasomnias.
Clinical Pearls
- Anecdotally, patients may report more restful sleep than benzodiazepines