Curr Drug Saf. 2014 Jun 1; DOI: 10.2174/1574886309666140601210422
Study objectives. Sleep maintenance problems are common, hence treatments enabling patients to fall asleep more rapidly after middle-of-the-night (MOTN) awakenings, without impairing next morning alertness, are needed. This literature review compares the effects of MOTN administration of various hypnotics on morning driving ability, a potentially dangerous daily activity under conditions of impairment. Methods. A literature search was conducted identifying on-the-road driving studies examining the effects of MOTN administration of hypnotics on morning driving performance. In a standardized 100-km highway driving test in normal traffic, subjects were instructed to drive with a steady lateral position and constant speed of 95 km/h. The primary outcome measure of the driving test is the Standard Deviation of Lateral Position (SDLP, cm), i.e. weaving of the car. Results. Four driving studies were identified. Driving performance after MOTN administration of traditional benzodiazepine hypnotics was not examined. Zolpidem (10 mg and 20 mg, oral immediate release tablets) significantly impaired driving in a dose-dependent manner, when tested 4 hours after MOTN administration. Also, gaboxadol (15 mg) and zopiclone (7.5 mg) significantly impaired next-morning driving after MOTN administration. In contrast, sublingual zolpidem (3.5 mg) and zaleplon (10 mg and 20 mg) did not significantly affect driving 4 hours after MOTN administration. Conclusions. Driving was not affected 4 hours after MOTN administration of sublingual zolpidem (3.5 mg) or zaleplon (10 mg and 20 mg). Significant driving impairment was found after MOTN administration of zolpidem (10 and 20 mg), gaboxadol (15 mg), and zopiclone (7.5 mg).
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ABC News Madeleine Morris 19 March 2014
The practice of mixing sleeping pills with alcohol and energy drinks is widespread in the National Rugby League, a club doctor has told the ABC.
John Mayhew, the doctor for the Auckland-based New Zealand Warriors, says he also believes the problem is widespread in other codes.
His comments come as the NRL begins testing players for the sleeping pill Stilnox and other prescription drugs, in addition to existing tests for steroids and other performance-enhancing substances.
PLoS ONE 2013; 8(6): e67459; DOI 10.1371/journal.pone.0067459
BACKGROUND: While an association between zolpidem use and fracture and road accident was previously proposed, this study aimed to further explore the frequency and risk of a wide spectrum of injuries in subjects prescribed with zolpidem in Taiwan. METHODS: We identified 77,036 subjects who received Zolpidem treatment between 2005 and 2007. We randomly selected 77,036 comparison subjects who were frequency-matched based-on their demographic profiles. We individually tracked each subject for a 90-day period to identify those who subsequently suffered an injury. Cox proportional hazards regressions were performed to calculate the hazard ratio of injury between the two groups. RESULTS: The incidence rate of injury during the 90-day follow-up period for the total subjects was 18.11 (95% CI = 17.69-18.54) per 100 person-years; this was 24.35 (95% CI = 23.66-25.05) and 11.86 (95% CI = 11.39-12.36) for the study and comparison cohort, respectively. After adjusting for demographic variables, the hazard ratio (HR) of injury during the 90-day follow-up period for study subjects was 1.83 (95% CI = 1.73-1.94) that of comparison subjects. Additionally, compared to comparison subjects, the adjusted HR of injury during the 90-day follow-up period for study subjects who were prescribed Zolpidem for >30 days was as high as 2.17 (95% CI = 2.05-2.32). The adjusted HR of injury to blood vessels for study subjects was particularly high when compared to comparison subjects (HR = 6.34; 95% CI = 1.37-29.38). CONCLUSIONS: We found that patients prescribed with Zolpidem were at a higher risk for a wide range of injuries.
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Sydney Morning Herald Steve Larkin & Rob Forsaith 22 February 2013
Eamon Sullivan apologised for being a ringleader as he and five other top Australian swimmers admitted lying about taking a banned drug before the London Olympics.
All six men’s freestyle relay swimmers, including world champion James Magnussen, could be banned from future Olympics for their abuse of the banned sedative Stilnox.
Brisbane Times Bradley Partridge & Wayne Hall 25 February 2013
Zolpidem (sold as Stilnox in Australia) is a prescription drug for the treatment of insomnia. So what role does it play in the lives of elite athletes?
In elite sports that require frequent international travel, such as swimming, Stilnox may be prescribed to help athletes cope with changes in their sleep cycle.
Stilnox is used for related reasons in other professional sporting leagues.
The Australian Glenda Korporaal 3 August 2012
SIX-TIME Olympic shooter Russell Mark has lashed out at the Australian Olympic Committee’s last-minute ban on the sleeping drug Stilnox.
in-Pharma Technologist.com Gareth Macdonald 10 July 2012
An insomnia treatment linked to sleepwalking and sleep driving should stay on the market according to the Australian Therapeutic Good Administration (TGA).
Sydney Morning Herald Amy Corderoy 6 July 2012
THE sleeping drug Stilnox should no longer be considered the safe alternative to other drugs because of its links to deaths and bizarre behaviour, a review has found. Stilnox and similar drugs contributed to the deaths of more than a third of the people who were taking them when they died violently or unexpectedly in NSW between 2001 and 2010, according to drug experts who reviewed the deaths.
They believe evidence of the harm caused by the drug is so strong it should now be routinely tested for in all violent and unexpected deaths. The study identified 91 deaths in which drugs containing zolpidem were involved, including 31 poisonings and two falls from great heights involving abrupt or bizarre behaviour.
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Sleep Medicine Reviews October 2011 15:5 (285-292) doi:10.1016/j.smrv.2010.12.004
Sleep driving is most often classified as a variant of sleepwalking, but should be distinguished from impaired driving due to misuse or abuse of sedative/hypnotic drugs. Z-drugs; zolpidem and zopiclone in particular, have been associated with the majority of reported cases of impaired driving. Numerous studies have found z-drugs in driving under influence (DUI) related police stops, arrests and accidents. Impaired drivers are reported to have 1) blood levels of z-drugs that exceed therapeutic ranges 2) failed to take the medication at the correct time or remain in bed for sufficient time and/or 3) combined z-drugs with other central nervous system (CNS) depressants and/or alcohol. Consistent with CNS depression, z-drug-impaired drivers may demonstrate cognitive function at low levels with drivers still able to understand and respond to questions while sleepwalkers are completely unable to understand or interact with police. Z-drug-impaired drivers are often severely physically impaired, unable to stand up or maintain balance while sleepwalkers are able to stand and walk unaided. Sleep driving and impaired driving due to z-drugs may overlap. Sleep driving and drug-impaired driving are statistically rare events, but due to the billions of doses prescribed each year may still result in numerous DUI related arrests and accidents.
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Int J Legal Med. 2011 Jul 13. [Epub]
In drug-facilitated crimes, victims are subjected to nonconsensual acts while they are incapacitated by the effects of a drug. A specific LC-MS/MS protocol for determining benzodiazepines and hypnotics at low concentration in hair specimens was developed and validated in order to target the allegedly administered drugs on a chronological basis. In the case hereby reported, a 26-year-old woman claimed to have been sexually assaulted after being administered an allegedly drugged coffee, but toxicological analysis of urine and blood provided no evidence of any drug intake. Subsequently, a second woman accused the same man of sexual abuse. Hence, the suspect was prosecuted. Specimens were collected from four subjects (two alleged victims, the suspect and his wife) and segmental hair analysis was performed. The results revealed that zolpidem was present at low picogram per milligram concentration in three out of eleven segments of hair specimen obtained from the first of the alleged victims, offering plain evidence of single or sporadic exposure, whereas the agent was detected in the high picogram per milligram range in the hair collected from suspect’s wife, coherently with therapeutic administration. The presence of interfering signals typical of the keratin-containing matrix was found and possible hair degradation by cosmetic treatments was investigated by electron microscopy, so as to obtain a judicious interpretation of the analytical findings.
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