15, 16, 20, 21 Compared to zopiclone, clonidine may afford better sleep, better analgesia, and fewer adverse effects and these outcomes may be particularly beneficial in chronic pain patients. Clonidine provides reliable anxiolysis, analgesia, and sleep but is not commonly employed for these useful qualities. 19 – 21 It produces predictable adverse effects of dry mouth, dizziness, and postural hypotension. 15 – 18 Clonidine provides effective therapy for restless legs, nightmare, and other sleep disorders. 9 – 14Ĭlonidine is an α 2-adrenoreceptor agonist drug that is used to treat hypertension, bruxism, attention-deficit/hyperactivity disorder, drug or substance withdrawal, menopausal hot flush, spasticity, and anxiety. Adverse effects include nausea, residual drowsiness, prolonged tiredness, dry mouth, headache, amnesia, confusion, depression, hallucination, sleepwalking, nightmares, incoordination, collapse, paradoxical excitation, drug dependence, withdrawal, and polysubstance use. ![]() Zopiclone use is controversial and associated with unpredictable effects. 9 – 11 Although zopiclone is molecularly different from benzodiazepines, it has a similar mode of action to benzodiazepines by increasing the transmission of the inhibitory neurotransmitter gamma-aminobutyric acid in the central nervous system. Zopiclone is a popular nonbenzodiazepine drug and is categorized as a cyclopyrrolone. 1, 5, 8 Prescription sleep medicines include zolpidem, zopiclone, lemborexant, lorazepam, nitrazepam, trazodone, temazepam, triazolam, flurazepam, and quetiapine. 5, 6, 8 Nonprescription sleep medicines include melatonin, antihistamines, chamomile, valerian, theanine, rhodiola, scutellaria, and passionflower. 4, 5, 7 However, a significant proportion of chronic pain patients may require pharmacologic therapy for insomnia. 4 – 6 Insomnia should be treated with nonpharmacologic modalities such as diet, psychotherapy, hypnotherapy, and cognitive behavioral therapy. 2, 3 Good sleep hygiene is essential for chronic pain management and improvement. 1, 2 Insomnia is part of the vicious cycle of pain propagation and central pain sensitization syndrome. Treatment of alcohol withdrawal should be followed by treatment for alcohol dependence.Chronic pain has negative impacts on sleep and is a major cause of insomnia. ![]() Medications such as haloperidol, beta blockers, clonidine, and phenytoin may be used as adjuncts to a benzodiazepine in the treatment of complications of withdrawal. Carbamazepine is an appropriate alternative to a benzodiazepine in the outpatient treatment of patients with mild to moderate alcohol withdrawal symptoms. Benzodiazepines, the agents of choice, may be administered on a fixed or symptom-triggered schedule. ![]() Pharmacologic treatment involves the use of medications that are cross-tolerant with alcohol. Most patients undergoing alcohol withdrawal can be treated safely and effectively as outpatients. ![]() Although the history and physical examination usually are sufficient to diagnose alcohol withdrawal syndrome, other conditions may present with similar symptoms. The spectrum of alcohol withdrawal symptoms ranges from such minor symptoms as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens.
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