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Sedatives

Sedatives include a wide number of medications, ranging from treatments used to help prepare someone for surgery to medications for anxiety. 

  1. Act on the central nervous system.
  2. Provide relief from anxiety.
  3. Are available in herbal form. 

If you would like to speak to one of our GPhC-registered clinicians about sedatives or any related conditions, you can book an appointment between 9.30am-4.30pm, Monday to Friday, using our online video consultation service. 

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Product information

What are sedatives?

Sedatives are groups of different medications, all of which act on the central nervous system in some way. Early versions of sedatives included barbiturates, which were prescribed to treat insomnia and anxiety. Later on, in the 20th century, these were replaced by benzodiazepines, most commonly diazepam (Valium). 

Barbiturates are still used today, to treat convulsions and to help induce anaesthesia, while benzodiazepines are prescribed for anxiety, muscle spasms and, in emergencies, epileptic fits. 

Another commonly prescribed sedative group are antihistamines. Not all antihistamines provide a sedative effect, but some, such as promethazine, can be prescribed to treat insomnia.

What is generalised anxiety disorder?

While anxiety is a perfectly normal response to stressful situations, such as preparing for a job interview, if it’s occurring persistently, on a daily basis, it can indicate generalised anxiety disorder (GAD). GAD is a chronic condition in which anxiety is a recurring, day-to-day experience. 

Anxiety can also be triggered by a number of other psychological conditions, including post traumatic stress disorder (PTSD), panic disorder (anxiety attacks), phobias (such as agoraphobia) and social anxiety disorder (fear of social situations). Anxiety is a life-changing condition that can lead to serious health problems if it is not managed.

What symptoms can generalised anxiety cause? 

A number of symptoms of anxiety can present at once, or in some cases you may only notice a few indications at any one time. They range from relatively mild (such as an unpleasant but manageable restlessness), to severe (such as major panic attacks and mood swings). A sense of dread may also manifest, as well as an inability to concentrate. This can lead to people socially isolating, which can make symptoms even more severe. 

Physical symptoms are also likely to present with anxiety, including fatigue, aching muscles, sweating, problems breathing, a dry mouth, nausea, headaches, pins and needles, insomnia and palpitations.

How is generalised anxiety disorder treated? 

Treatment for anxiety typically includes either a single medication, a mix of medications and one or various talking therapies. Sometimes medication and talking therapies are both used, and this is called combination therapy. 

Generalised anxiety disorder is usually a long-term condition, so your doctor will likely need to consider this when prescribing any treatment. Sedatives can be effective in the short-term, but because many of these treatments have a high risk of dependency, they are not thought to be suitable for long-term use. 

Antidepressants are better suited to treat long term mental health issues, as they do not carry the same risks of addiction and can treat related symptoms, such as depression. Older forms of antidepressants include monoamine oxidase inhibitors (MAOIs) such as phenelzine and tricyclic antidepressants (TCAs) such as amitriptyline, while newer forms include selective serotonin reuptake inhibitors (SSRIs) such as citalopram and serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine. 

Talking therapies are varied and the most suitable type for you depends on the causes and symptoms of your anxiety. One of the most effective methods of controlling the symptoms of anxiety is cognitive behavioural therapy (CBT). CBT works by helping you to manage negative thought patterns, which may cause you to catastrophize situations (expect the worst outcomes in situations) or to fixate on potential, detrimental outcomes. A course of CBT usually consists of 12 to 20 sessions, and can also be an effective treatment for depression, eating disorders and phobias.

What is insomnia?

Insomnia refers to an inability to sleep properly. This may entail not being able to sleep at night, or not being able to stay asleep throughout the night. Symptoms of insomnia include an inability to concentrate, fatigue (particularly upon waking), problems staying awake during the day and irritability. 

In the long term, insomnia can lead to various mental health problems if left untreated. The amount of sleep you need varies from person to person and depends on your age group. Toddlers and babies require more sleep than adults, ranging from 12 to 17 hours a day, while children should aim for around nine to 13 hours per day. Adults require anything between seven and nine hours a day. 

What causes insomnia? 

Causes of insomnia can vary. Usually, insomnia is caused by mental health issues, such as stress, anxiety and depression, or environmental factors, such as noise and discomfort. Other common causes include drugs and alcohol, jet lag and unsocial work hours (such as night shifts).

How is insomnia treated?

Insomnia can usually be treated by making changes to your lifestyle. For example, going to bed and waking at the same time every day. Trying to relax for at least one hour before bed by reading, or having a hot bath, are measures that may also help. Ensuring that your sleep environment is comfortable can help you to sleep better, ensuring that the temperature is not too hot or cold. Using ear plugs and a mask if the room is too bright may be effective treatment methods too. 

Exercising during the day can be beneficial to a good night’s sleep overnight, and refraining from eating big meals, and drinking alcohol and caffeine within six hours before bed, may help to combat insomnia. Avoiding exercise within four hours of going to bed, and giving yourself at least one hour away from screen and bright lights in general, are further measures that can help you to manage the condition. 

It’s also important to avoid sleeping in if you’ve had a bad night’s sleep, and to try and maintain a steady sleep pattern. 

Medication should be a last resort treatment option for insomnia, and only used when all other methods have proven ineffective. Many sleeping aids are not suitable for long-term use, but they can provide some relief in the short-term if your symptoms are severe enough to warrant them. As is the case with all sedatives, they can produce effects the following day where you might not be at your most alert. CBT has also proven to be effective for some people with insomnia, particularly if it’s triggered by anxiety.

What is epilepsy? 

Epilepsy is a relatively common condition in the UK that is caused by short electrical bursts in the brain that trigger fits. It can present at any age, although it usually develops during childhood, or in people over the age of 60. While there is no cure for the condition, it can improve significantly over time. The most common symptom of epilepsy is seizures, of which there are many different types, depending on which part of the brain is affected.

What causes seizures in epilepsy? 

Triggers for epileptic fits can vary from person to person and, contrary to popular belief, rarely include flashing lights. In fact, many seizures occur randomly, without any apparent reason. Known triggers, however, include alcohol and drugs (including medications), stress, lack of sleep, hormone changes (such as during the menstrual cycle) and waking.

What types of seizures are there in epilepsy? 

Simple partial seizures (auras), include a rising feeling in the stomach, as well as a sense of déjà vu (feelings that you have experienced this moment before). Tingling in the legs and arms may also be present, as well as changes in your sense of smell and taste. 

Complex partial seizures are typically characterised by a loss of awareness, and strange bodily movements that you have no control over. These include the smacking of your lips, rubbing of your hands, making random noises, chewing, swallowing and fiddling with objects, often your clothing. It is unlikely that you will have any memory of the seizure after it has subsided. 

Tonic clonic describes the two phases of seizures. Tonic refers to a loss of consciousness and collapsing, while clonic refers to the violent jerking of the body that occurs after this. During this time, you may also lose control of your bladder and bowels. Tonic and clonic seizures can also occur individually of one another.

Other seizures include absences (loss of awareness), myoclonic seizures (minute jerking that can occur in clusters), atonic seizures (where your muscles relax) and status epilepticus seizures. Status epilepticus  are the most dangerous type of seizures, and can lead to someone losing consciousness for long periods of time. Seizures may occur continuously whilst you are unconscious, and require immediate medical treatment.

How is epilepsy treated?

Treatment for epilepsy may include dietary changes, medication and surgery. Ketogenic diets, where carbohydrates are reduced, can change the chemical make-up of the brain. It has been found to be particularly effective in treating children. Medications for epilepsy are varied and have been proven to help around 70% of people with the condition. 

Which type of anti-epileptic drug (AED) is most suitable for you depends on a number of factors, including whether you are pregnant, your age and what type of seizure you are experiencing. On rare occasions, sedatives, such as benzodiazepines, can be employed to control symptoms. 

Surgery is generally only used to treat epilepsy when other treatments have proven ineffective or unsuitable. They may also be unsuitable if the part of the brain affected by the condition is dangerous to operate on. Brain surgery requires the removal of a small part of the brain that is being affected. Other treatments include Vagus nerve stimulation (where a small device is fitted to the chest to control electrical bursts like a pacemaker) and deep brain stimulation (similar to vagus nerve stimulation but bursts are sent directly to the brain). 

If you would like to discuss sedatives or any related conditions with a registered clinician, our online video consultation service is available from 9.30am-4.30pm, five days a week. Our clinicians can also issue fit notes and referrals to specialists for treatment, where suitable.  

Page last reviewed:  21/07/2020
Side effects and warnings

What side effects can sedatives cause? 

All medications come with some risk of side effects, and this includes over the counter treatments and herbal supplements. It’s important that you are aware of any potential side effects before starting your course of medication. Your prescribing clinician can discuss side effects with you, and the patient information leaflet that comes with your treatment should list all known side effects. 

The following information relates to the sedative diazepam, and may not be relevant for your treatment.

If you experience any of the following, discontinue use and seek immediate medical assistance: 

Uncommon (may affect up to 1 to 100 people): respiratory depression. 

Rare (may affect up to 1 in 1,000 people): respiratory arrest, unconsciousness, jaundice. 

Very rare (may affect up to 1 in 10,000 people): allergic reactions, wheezing, swelling of your lips, tongue, throat or body, rashes, loss of consciousness or problems swallowing. 

Other symptoms include:

Very common (may affect more than 1 in 10 people): drowsiness 

Common (may affect up to 1 in 10 people): fatigue, withdrawal symptoms, confusion, loss of coordination of muscle movements, other movement disorders and tremors. 

Uncommon (may affect up to 1 in 100 people): muscle weakness, memory loss, problems concentrating, balance disorders, dizziness, headache, slurred speech, nausea, vomiting, constipation, diarrhoea, increased salivation and allergies. 

Rare (may affect up to 1 in 1,000 people): excitation, agitation, restlessness, irritability, aggressiveness, memory loss, inappropriate behaviour, delusion, rages, psychoses, nightmares, hallucinations, decreased alertness, depression, emotional withdrawal, insomnia, bradycardia, heart failure, cardiac arrest, low blood pressure, increased mucus in the lungs, dry mouth, increased appetite, changes in liver enzymes as seen in blood tests, unable to urinate, loss of bladder control, breast enlargement in men, impotence, changes in libido, blood disorders, sore throats, nose bleeds or infections.

Very rare (may affect up to 1 in 10,000 people): low levels of white blood cells and high levels of  certain enzymes in the blood.

The following symptoms have also occurred, but their frequency has yet to be determined: blurred vision, double vision and involuntary eye movements.

Can sedatives cause interactions with other medications? 

It’s important that you tell your doctor about any other medications you are currently taking or have recently taken before starting treatment with sedatives. All substances have the potential to interact in a negative way in the body, including over the counter medications and herbal supplements, so only by informing your doctor about these will they be able to prescribe these treatments safely. 

It’s particularly important that you tell your doctor if you are taking any of the following: Sodium oxybate, antidepressants, antipsychotics, antihistamines, general anaesthetics, other sedatives, hypnotics, erythromycin, muscle relaxants, strong pain killers (opioids), medicines to lower high blood pressure, diuretics, nitrates and antacids. 

The following medications may also affect your mental breathing or blood pressure when taken alongside diazepam: Disulfiram, medicines for epilepsy, sodium valproate, theophylline, cimetidine, omeprazole, esomeprazole, rifampicin, hypericum perforatum (Perforate St John’s wort), amprenavir, atazanavir, ritonavir, delavirdine, efavirenz, indinavir, nelfinavir, zidovudine, saquinavir, fluconazole, itraconazole, ketoconazole, voriconazole, isoniazid, oral contraceptives, cisapride, corticosteroids, levodopa, valproic acid, ketamine, lofexidine, nabilone, alpha blockers, beta blockers or moxonidine.

Warnings and precautions when taking sedatives 

It’s imperative that you tell your prescribing clinician about any conditions that you have, whether related to the use of sedatives or not, before you start treatment.

You should avoid using diazepam with any of the following: allergies to diazepam or other benzodiazepines, breathing problems, depression or hyperactivity, phobia, other mental illness, myasthenia gravis, sleep apnoea, severe liver disorders or porphyria.

Your doctor will also need to weigh up the benefits and risks involved if any of the following applies to you: history of alcoholism or drug abuse; have problems with your heart; problems with your lungs; severe kidney failure; you are grieving; have low blood levels of albumin; personality disorder; poor blood supply to the brain; are elderly; have breathing difficulties; smoke; have depression; have suicidal thoughts; epilepsy; a history of seizures.

Can you take sedatives if you are pregnant?

Because there are a number of different types of sedatives available, guidance on their use whilst pregnant or breastfeeding may vary. You should therefore inform your doctor if you are pregnant, think you might be pregnant, are planning on becoming pregnant during treatment or are breastfeeding, before use. 

Page last reviewed:  21/07/2020
Questions and Answers

Can sedatives affect your ability to drive? 

Sedatives are likely to affect your ability to drive, so it is essential that you avoid operating any form of heavy machinery if you feel sleepy, dizzy, are having problems concentrating or have poor coordination. If you are experiencing any of these effects or are unsure, consult your clinician.  

Can I consume alcohol whilst taking sedatives? 

Because alcohol can significantly increase the effects of sedatives, you should avoid consuming alcohol for the duration of your treatment. 

Can I buy sedatives over the counter? 

It depends on the sedative. Herbal sedatives are available in most health food stores and supermarkets, but stronger treatments require a prescription. 

Can I buy sedatives online? 

You can speak to a GMC-registered clinician about sedatives and any related conditions via our online video consultation service. Appointments are available between 9.30am-4.30pm, Monday to Friday. Our clinicians can also provide referrals to specialists for treatment and fit notes, where appropriate. 

 

Page last reviewed:  21/07/2020

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