4 Anxiolytics and Sedatives

Purpose and onset

Anxiolytics reduce anxiety, while sedative-hypnotics slow central nervous system activity and may promote sleep. These groups differ in purpose, onset, effects, risks, and appropriate uses. Medicines in either group can cause drowsiness and impaired coordination.

How common medicines differ

Buspirone is an anti-anxiety medicine generally taken on a regular schedule, not for immediate relief. It may take weeks to begin working. If a dose does not help during a sudden episode of anxiety, do not take extra doses unless the prescriber directs it. Follow the prescribed schedule and discuss persistent or worsening symptoms with the prescriber.

Benzodiazepines, such as lorazepam, may be prescribed for anxiety and other specific conditions. They can be useful for selected indications, but carry risks of dependence and withdrawal and require careful prescribing and monitoring.

Zolpidem is a sedative-hypnotic used for insomnia. Hydroxyzine is an antihistamine sometimes used for anxiety; it can cause drowsiness.

Interactions and impairment

Alcohol, opioids, and other medicines that cause sleepiness can intensify central nervous system depression. This can lead to extreme sleepiness, impaired coordination, slowed or difficult breathing, overdose, or death. Do not assume a combination is safe: ask a clinician or pharmacist about possible interactions before combining medicines or substances.

Take medicines only as prescribed. Tell the prescriber and pharmacist about prescription medicines, over-the-counter products, supplements, alcohol, and other substances. Do not take someone else's medicine or share your own. Avoid alcohol and do not add other sedating medicines without professional advice.

Do not drive or operate machinery when drowsy or impaired. For hydroxyzine, avoid driving or operating machinery until you know how it affects you, and ask a health professional about alcohol because it may worsen side effects.

Changing benzodiazepine treatment

Regular benzodiazepine use should not be stopped abruptly or reduced too quickly, because this can cause serious withdrawal, including seizures. Contact the prescriber to plan an individualized gradual taper. Do not stop or change the dose on your own.

Precautions with zolpidem

Take zolpidem only as directed, at bedtime. Do not combine it with alcohol or another sleep medicine unless a health professional directs you to do so. Impairment may persist into the next day, so avoid driving or other hazardous activities if drowsy or impaired.

Complex sleep behaviors, such as sleepwalking, sleep-driving, or cooking while not fully awake, can cause serious injury. If one occurs, stop the medicine and contact a health professional promptly.

Recognizing an emergency

Being difficult to wake after taking a sedative, especially with slow or difficult breathing, is a medical emergency. Call 911. Do not give more medication, alcohol, or food or drink. Sedatives, particularly when combined with alcohol, opioids, or other central nervous system depressants, can dangerously suppress breathing.