US EPA

724271 

Journal Article 

Properties of hypnotic drugs and the extent of their use in the Netherlands 

Vulto, AG 

1978 

4/2 (65-77) 

Sleep is not only the absence of wakefulness. Many people take sleeping tablets when they are suffering from insomnia. There are several types of hypnotics, with varying toxicity and efficacy. In particular the benzodiazepines flurazepam (Dalmadorm) and nitrazepam (Mogadon) have become increasingly popular. However, their duration of action is much too long for a single night's sleep of approximately 8 hours. From the point of view of the elimination rate oxazepam (Seresta) might be a better choice as hypnotic, although the effectiveness has yet to be established. Other groups of hypnotics, such as the barbiturates and related drugs, have only distinct disadvantages compared with the benzodiazepines: most compounds are toxic at relatively low doses, while tolerance may develop during chronic use. Frequent use of the barbiturates may result in dependence and major problems with these drugs are encountered in handling intoxications. Most members of this group of drugs act too long, with hangover side-effects lasting into the day after intake. Similar objections can be made against glutethimide (Doriden) and methaqualone (Revonal). Most of the combinations of hypnotics (e.g. Vesparax, Ballanox, Mandrax, Isonox) are irrationally compounded and should therefore not be used. Tolerance will rapidly develop with most of these preparations. One should avoid developing the habit of taking sleeping tablets when going to bed. Apart from physical dependence, psychological dependence may also arise. It should be noted that there are several non-medicinal alternatives for regaining a physiological, non drug-dependent sleep. In 1977 there were almost 138 x 10sup 6 Defined Daily Doses (D.D.D. = daily doses which can be regarded to be representative for regular, non-excessive use) of hypnotics sold in the Netherlands. That means that more than 4% of the adult Dutch population may have been taking hypnotics chronically in 1977. The long-acting benzodiazepines flurazepam and nitrazepam accounted for 75% to the total amount of D.D.D.'s sold. The use of barbiturates is declining, but is still comprises (alone or in combination) some 17% of the total sales of D.D.D.'s. One may therefore conclude that hundreds of thousands of the Dutch population live and work under the influence of consciousness lowering hypnotics having a duration of action which is too long 

barbituric acid