Top 300 Drugs: Anti-Anxiolytics Sedative-Hypnotics and Stimulants

Benzodiazepines

Boost GABA to produce an anxiety reducing and sedative effect

All are Schedule IV controlled substances; risk of over-sedation

Respiratory depression when combined with alcohol or opioids

Must taper to discontinue chronic use

Clonazepam

Klonopin

Alprazolam

Xanax

Diazepam

Valium; injectable and oral formulations; also used for seizures

Chlordiazepoxide

Librium; also used for alcohol withdrawal

Midazolam

Versed; used as an IV push or continuous infusion for sedation

Lorazepam

Ativan; injectable and oral formulations; used for status-epilepticus

Benzodiazepines common indications

Anxiety, alcohol withdrawal, status epilepticus

Benzodiazepines side effects

Sedation, respiratory depression, abuse/misuse, withdrawal risk

Benzodiazepines important interactions

alcohol and other CNS depressants

Buspirone

Brand name = buspar

General anti-anxiolytic medication used for anxiety; lacks heavy sedation or risk of abuse that benzodiazepines carry

Slow onset of action

Increases serotonin → careful with other serotonergic medications and CI with MAOIs

Non-Benzodiazepine Hypnotics

“Z-drugs”: promote sleep with a more selective GABA action than BZDs

Schedule IV controlled substances

Can cause complex sleep behaviors

Additive CNS depression with alcohol/BZDs/opioids

Eszopiclone

Lunesta

Zolpidem

Ambien

Zaleplon

Sonata

Z Drugs common indications

Insomnia

Z drugs side effects

complex sleep behaviors

Z Drugs important interactions

CNS depressants (alcohol, BZDs, opioids)

CNS Stimulants

Increases dopamine and norepinephrine → better focus, alertness

Schedule II controlled substances

Common side effects include insomnia and decreased appetite

Serious side effects include cardiac events, severe hypertension, and risk for misuse/abuse

Amphetamine/dextroamphetamine

Adderall; IR vs ER

Dexmethylphenidate

Focalin

Methylphenidate

Ritalin, Concerta, Daytrana (patch); many formulations

Lisdexamfetamine

Vyvanse

CNS Stimulants common indications

ADHD

CNS Stimulants side effects

Insomnia, weight loss, CV events/HTN, abuse/misuse

CNS stimulants important interactions

MAOIs → hypertensive crisis

Atomoxetine

Brand name = Strattera

Non-stimulant ADHD agent

Not controlled; boxed warning for suicidal ideation

Same MAOI warning as stimulants