A Double-Blind Comparison of the Effects of Temazepam and Triazolam on Residual, Daytime Performance in Elderly Insomniacs

Nakra, B. R. S.; Gfeller, Jeffrey D.; Hassan, Rakhshanda

doi:10.1017/s1041610292000899

Cited by 16 publications

(5 citation statements)

References 7 publications

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“…Blood samples showed an increase in plasma concentrations of 50% over 7 days of treatment, supporting the inference that only limited clearance of the drug and its metabolites had occurred over time. Temazepam (15 and 30 mg) given at bedtime to elderly patients with insomnia did not impair psychomotor function nor memory when tested 12 to 14 hours after the drug was administered [56]. In 8 elderly insomniacs, temazepam (7.5 mg) did not produce significant memory impairment during a 7-day treatment period nor in the following drug discontinuation period [57].…”

Section: Temazepammentioning

confidence: 91%

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Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Verster¹,

Volkerts²,

Spence

et al. 2007

CPSR

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Sleep disturbances occur more often in the elderly than in patients in any other age category. Traditional treatment regimens for insomnia in older patients have emphasized benzodiazepines. The useful anxiolytic and hypnotic properties of these agents have made them the most widely prescribed class of drugs in the world. Concern has been expressed however about the significant side effect profile associated with these agents. There is now considerable evidence that all benzodiazepines show significant dose-dependent impaired daytime performance on a variety of memory, cognitive and psychomotor tests. In addition, the risk of falls, hip fractures, and traffic accidents is significantly increased in patients who are treated with benzodiazepines. There is little evidence that benzodiazepine hypnotics are still effective after chronic use. On the other hand, several impairments persist when using these hypnotics over long time. Recently, the nonbenzodiazepine drugs zolpidem and zaleplon have been introduced and are claimed to be relatively safe (i.e. less daytime sedation) when compared to benzodiazepines. Zopiclone, a non-benzodiazepine hypnotic, shows no advantages over benzodiazepines with respect to daytime performance.Several factors may interact with the effects of hypnotics on daytime functioning, including normal cognitive decline during aging, the effects of insomnia itself on daytime functioning, the presence or absence of co-morbid disorders, and pharmacokinetic changes accompanying aging. The impact of hypnotics on daytime performance further depends on various drug-related factors including the administered dose, half-life, time between intake and performance, duration of treatment, gender, and individual differences.In contrast, zolpidem and zaleplon do not significantly impair daytime performance when administered at bedtime at the recommended dose. Although further studies of drug effects in elderly insomniacs are necessary, the available evidence suggests that these short acting and relatively safer non-benzodiazepine hypnotics are a preferred alternative therapy for treating insomnia in the elderly.

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Section: Temazepammentioning

confidence: 91%

“…Further, triazolam (0.125 mg) did not produce significant psychomotor impairment in geriatric inpatients after either 1 or 5 days of bedtime administration [47]. Other studies have also failed to find significant psychomotor impairments after administration of triazolam [46,56].…”

Section: Triazolammentioning

confidence: 95%

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Verster¹,

Volkerts²,

Spence

et al. 2007

CPSR

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“…In addition older people are more likely to use medications which can negatively effect driving performance. Moreover the elderly are more susceptible to over-medication and multiple drug interactions (Leveille et al, 1994;Nakra, Geller and Hassan, 1992;Nicholson, 1986).…”

Section: Safety Implicationsmentioning

confidence: 99%

Automobility among the Elderly

Rosenbloom,

Ståh

2002

European Journal of Transport and Infrastructure Research

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“…Newer benzodiazepine‐like agents such as the imidazopyridine zolpidem also have cognitive‐impairing effects (Mintzer et al ., 1997). For short‐acting agents such as zolpidem and the triazolobenzodiazepine triazolam such cognitive effects may be somewhat less important when these drugs are used at bedtime for sleep, although some individuals are susceptible to ‘hang‐over’ effects; most cognitive effects generally do not persist past 6 h postingestion (Wesensten et al ., 1996), with exceptions in some populations (Nakra et al ., 1992). However, retrograde amnestic effects including the disruption of sleep‐dependent memory consolidation could have significant, negative clinical, and social outcomes.…”

Section: Introductionmentioning

confidence: 99%

Retrograde effects of triazolam and zolpidem on sleep-dependent motor learning in humans

Morgan

Kehne²,

Sprenger³

et al. 2010

Journal of Sleep Research

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SUMMAR Y Drugs that act as allosteric activators at the benzodiazepine site of the gammaaminobutyric acid (GABA A ) receptor complex are used commonly to treat insomnia but relatively little is known of how such use affects learning and memory. Although anterograde effects on memory acquisition have been shown, possible retrograde effects on consolidation are more relevant when such agents are administered at bedtime. We tested the effects of two GABA A allosteric activators on sleep-dependent motor skill memory consolidation in 12 healthy male subjects. Subjects slept in a sleep laboratory for four consecutive nights (one accommodation night followed by three experimental nights). Placebo, triazolam 0.375 mg, and zolpidem 10 mg were given to each subject in counterbalanced order on the experimental nights. Polysomnographic (PSG) sleep measurement and sleep-dependent motor learning were assessed at each condition. Triazolam was associated with longer total sleep time and increased Stage 2 sleep. Both zolpidem and triazolam were associated with increased latency to rapid eye movement (REM) sleep. Overnight motor learning correlated with total sleep time in the placebo condition but not in the triazolam or zolpidem conditions. A statistically significant impairment in motor performance occurred overnight in the triazolam condition only. Triazolam, given in sufficient doses to prolong sleep in healthy people, affected overnight motor learning adversely. Zolpidem, in a dose sufficient to prolong REM onset latency but without other effects on PSG-measured sleep, degraded the relationship between total sleep time and overnight motor learning. These data indicate that non-selective or a1-preferring benzodiazepine site allosteric activators can interfere with sleep-dependent memory consolidation.

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A Double-Blind Comparison of the Effects of Temazepam and Triazolam on Residual, Daytime Performance in Elderly Insomniacs

Cited by 16 publications

References 7 publications

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Automobility among the Elderly

Retrograde effects of triazolam and zolpidem on sleep-dependent motor learning in humans

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