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Onset of action
Half-life (h)
Active metabolites
Fast to intermediate
12 15
No
Intermediate
8 28
Yes
Clonazepam
Slow
18 50
No
Dipotassium clorazepate
Fast
48
Yes
Diazepam
Fast
20 50
Yes
Estazolam
Fast
10 24
No
Lorazepam
Intermediate
10 20
No
Oxazepam
Intermediate to slow
5 20
No
Prazepam
Slow
70
Yes
Intermediate to slow
9.5 12
No
Triazolam
Fast
1.7 5
No
Midazolam
Fast
14
No
Brotizolam
Fast
Yes
Loprazolam
Fast
58
Yes
Lormetazepam
Fast
12 20
No
Flunitrazepam
Fast
19 22
Yes
Flurazepam
Fast
40 114
Yes
Nitrazepam
Fast
24
Yes
Quazepam
Fast
25 41
Yes
Fast
1.5 4.5
No
Benzodiazepine anxiolytics
Alprazolam
Chlordiazepoxide
Temazepam
Benzodiazepine hypnotics
Non-benzodiazepine hypnotics
Zolpidem
Zopiclone
Fast
36
Yes
Zaleplon
Fast
No
Drug
Rebou
nd
and
PSG in
residu
healthy ACP
al
individu effect effects Laten
b
Half-life
als
sa
cy
Tot
al
sle Delt
Slee
ep
a
p
tim sle RE quali Comme
e
ep M
ty
nts
Benzodiazepine hypnotics
Triazolam
Short
Midazolam
Short
Brotizolam
Short
Loprazola
m
Intermed
iate
<path Rebou
ol.
nd
ACP insomn
rate
ia
! stage 2
Rebou
nd
insomn
ia
!stage 2
Rebou
nd
insomn
ia
! stage 2
Rebou
nd
insomn
ia
! stage 2
Lormetaze Intermed
pam
iate
Rebou
nd
insomn
ia
!stage 2
Flunitrazep Intermed
am
iate
! slow
waves
<
latenci
es in
MSLT.
No
!stage 2
reboun
d
Flurazepa
m
Long
! slow
waves
<
latenci
es in
MSLT.
No
reboun
d
! stage 2
Nitrazepa
m
Long
<
latenci
es in
MSLT.
No
reboun
d
!stage 2
Quazepam
Long
<
latenci
es in
MSLT.
No
reboun
d
! stage 2
Non-benzodiazepine hypnotics
Zolpidem
Short
No or <path
No
few
ol. reboun
changes ACP
d or
rate residu
al
effects
!!
!!
! waking
Zopiclone
Short
No or <path
No
few
ol. reboun
changes ACP
d
rate
!!
!!
! waking
Zaleplon
Short
No
changes
No
reboun
d or
advers
e
effects
characterised in the EEG by limited duration waves that can appear spontaneously or
after waking stimuli. <ACP means that these compounds decrease the ACP index.
b Confirmed by the multiple sleep latency test ( MSLT). < = decreases.
c No conclusive data.
Drug/chemical class
(half-life)
Reboun
d
Hangov insomni Toleranc Dependenc
er effect
a
e
e/ abuse
Comment
Benzodiazepine hypnotics
Triazolam/Benzodiazepin
e (short: <6h)
+++
+++
++
Midazolam
+++
+++
++
Brotizolam
+++
+++
++
Loprazolam/Benzodiaze
pine (medium: 6 24h)
+/++
++/+++
++/+++
++
Lormetazepam
+/++
++/+++
++/+++
++
Flunitrazepam
+/++
++/+++
++/+++
++
Flurazepam/Benzodiaze
pine (long: >24h)
+++
0b
++
Triazolam may
have fewer
respiratory
depressive
effects than
other
benzodiazepin
es. No more
than 0.25mg
should be
administered to
avoid
increasing
adverse CNS
effects
More marked
hangover effect
at higher doses
Avoid in
elderly, since
increased risk
of falls and
fractures
Nitrazepam
+++
0b
++
Quazepam
+++
0b
++
Non-benzodiazepine hypnotics
Zolpidem/Imidazopyridin
e (short)
Hangover
effect and
tolerance can
occur with
supratherapeuti
c doses and/or
very long-term
treatment
Zopiclone/Cyclopyrrolon
e (short)
++
++
++
Doses >7.5mg
increase
adverse effects
without
improving
efficacy
No sedation
seen on
following day, 5
6.5h after
10mg taken at
midnight, with
no significant
psychomotor
changes
Zaleplon/Pyrazolopyrimid
ine (short)
after 5
wks
Memory
Psychomotor
Night of
administration
Following
day
performance
Short-acting benzodiazepine
hypnotics[76]
!!
Intermediate-acting
benzodiazepine hypnotics[76]
! or !!
Long-acting benzodiazepine
hypnotics[76]
!! or !
!!
!!
Zopiclone[50,51,66]
!!
!! or !
Zaleplon[40]
!!
!!
!!
Zolpidem[51]
Treated
OSAS
Cardiac
function
Short-acting
benzodiazepine hypnoticsa
Intermediate-acting
benzodiazepine hypnotics
Long-acting
benzodiazepine hypnotics
Zolpidem
!!
!!
!!
Zopliclone
!!
!!
Zaleplon
?!!
?!!
Drug
a In mild to moderate stable diseases, triazolam does not impair oxygen saturation
COPD = chronic obstructive pulmonary disease; OSAS = obstructive sleep apnoea
syndrome; ! = Worsening; ? = inconclusive or missing data; !! = no changes.
Efficacy
Untoward effects or
complications
Tolerability
Benzodiazepine
hypnotics
Good
Good
Zolpidem
Good
!!
Good
Zopiclone
Good
!! or !
Good
Zaleplon
Good
!!
Good
Drug
ICD-9
name
1a. Adjustment
sleep disorder
code
name
ICD-10
code
name
DSM-IV
code
name
code
1b.
307.42- Persistent 307.4 Non-organic F51.0 Primary 307.4
Psychophysiologic 0
disorder of 2
insomnia
insomnia
al insomnia
initiating or
maintainin
g sleep
Other
insomnia
5c. Central
alveolar
hypoventilation
syndrome
780.511
5f. Altitude
insomnia
289
307.49.
0
337.9
11. Idiopathic
insomnia
780.52. Other
7
insomnia
Other
altitude
effects
Altitude
insomnia
289
T20.2
Fatal
familial
insomnia
337.9 Other
G31
degenerativ
e diseases
Insomnia 780.
due
X
to ..
.indicate
medical
patholog
y