Efficacy and safety of midazolam and oxazepam in insomniacs.

Lupolover, R; Ballmer, U; Helcl, J; Escher, Johanna C.; B, Pavletic

doi:10.1111/j.1365-2125.1983.tb02285.x

Cited by 6 publications

(4 citation statements)

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“…The studies by Feldmeier and Kapp and Gallais et al reported a statistically significant reduction in sleep latency with midazolam (15 mg orally) compared to placebo (median difference of 30–53%, p<0.05); however, only Feldmeier and Kapp 34 found oxazepam (15 mg orally) to be superior to placebo (median difference 16%, p<0.05). Gallais et al 35 found midazolam 15 mg orally to be superior to oxazepam 50 mg orally ( table 3 ) as did Lupolover et al 36 (15 mg doses for midazolam and oxazepam), but only after 3 days of treatment ( table 3 ).…”

Section: Resultsmentioning

confidence: 89%

“…Two randomised controlled trials, Feldmeier and Kapp 34 (n=50) and Gallais et al 35 (n=51), compared the effects of midazolam and oxazepam to placebo. One randomised controlled trial by Lupolover et al 36 (n=78) compared midazolam to oxazepam. Sleep latency was measured by third-party observation or patient questionnaire in all three studies.…”

Section: Resultsmentioning

confidence: 99%

“…Four reported no differences between drugs and/or placebo. 34 37 38 41 The study by Lupolover et al 36 described an improved state on awakening by patient self-report in those taking midazolam compared to oxazepam.…”

Section: Resultsmentioning

confidence: 99%

“… 37 Allergic type skin reactions were reported in two patients—one was associated with triazolam; the other, described as pruritus, occurred in a patient with pancreatitis and whether the reaction was attributed to benzodiazepines or placebo was not specified in the study. 36 38 …”

Section: Resultsmentioning

confidence: 99%

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Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

et al. 2016

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ObjectivesPatients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.Setting/participantsWe searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.Primary and secondary outcome measuresTwo reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.ResultsAfter screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.ConclusionsThere is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

et al. 2016

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Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Kanto

1985

Pharmacotherapy

180

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Midazolam is a 1,4-benzodiazepine derivative with a unique chemical structure: depending on environmental pH, the drug can produce highly water-soluble salts (pH less than 4) or exist in lipophilic diazepine ring-closed form (pH greater than 4). This characteristic contributes to rapid onset of action and to good local tolerance after parenteral administration. After both oral and parenteral administration, midazolam has a fast absorption rate and is rapidly excreted, with a half-life of only about 2 hours. A reasonably good correlation has been found between plasma levels and clinical effects, indicating a fast but brief response. As a hypnotic, midazolam is mainly indicated in insomniac patients with difficulties in falling asleep or having a pathologic sleep pattern during the first half of the night. No marked hangover effects are present the next morning. In anesthesiology, midazolam appears to be a useful, short-acting, sedative-anxiolytic and amnesic premedicant after both oral and parenteral administration. In minor surgery, however, the slow, unpredictable onset and variable duration of action, as compared with thiopental, may inhibit its routine use as an induction agent, especially in young patients, without heavy premedication. In major surgery, midazolam is an alternative to thiopental for induction of anesthesia in spite of its slow, variable induction time. Its advantages include good cardiovascular stability, transient and mild respiratory depression, low frequency of venous irritation, production of anterograde amnesia and short duration of action in comparison with other benzodiazepines.

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Development of physical dependence on midazolam by oral self-administration

Falk

Tang

1987

Pharmacology Biochemistry and Behavior

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Efficacy and safety of midazolam and oxazepam in insomniacs.

Cited by 6 publications

References 1 publication

Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Development of physical dependence on midazolam by oral self-administration

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