Sedatifs

Sedatifs, or sedatives, are medicines or substances that depress the central nervous system to produce calmness, reduced anxiety, and, at higher doses, sleep. They are used to treat short-term anxiety, agitation, insomnia, and as premedication for medical procedures. In practice, the term can overlap with hypnotics (sleep-inducing drugs) and anxiolytics (anxiety-reducing drugs).

Most sedatives work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), which inhibits neuronal activity. This leads to relaxation, drowsiness, and sometimes sleep. Other sedatives act through different pathways, such as histamine or certain serotonin receptors, to achieve similar calming effects.

Common classes include:

- Benzodiazepines (for example diazepam, temazepam, lorazepam), effective for anxiety and insomnia but associated with tolerance, dependence, and cognitive impairment in older adults.

- Non-benzodiazepine sedative-hypnotics, often called Z-drugs (zolpidem, zaleplon, eszopiclone), used mainly for sleep with potentially lower daytime sedation but still carry dependence risks.

- Barbiturates (older agents like phenobarbital, pentobarbital) with higher overdose risk and narrower safety margins; used less frequently today.

- Antihistamines with sedative effects (e.g., diphenhydramine) and certain sedating antidepressants or antipsychotics, sometimes used off-label.

Safety and regulation emphasize cautious, short-term use, careful dosing, and monitoring for side effects, dependence, withdrawal, and interactions with alcohol or other depressants. Alternatives for insomnia or anxiety include non-drug approaches such as cognitive-behavioral therapy and sleep hygiene. Sedatives are typically prescribed and supervised by healthcare professionals to balance benefits and risks.