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New Sleep Medication not Effective for Treating Abuse or Cognitive Impairment

In a study of 14 adults with histories of sedative abuse, the newly approved sleep medication ramelteon does not appear// to have effects that indicate potential for abuse or motor or cognitive impairment, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

About 10 to 15 percent of adults regularly experience chronic insomnia, difficulty sleeping that causes distress or impaired daytime functioning, according to background information in the article. Some of the medications most commonly used to treat the condition (known as benzodiazepine receptor agonists) have a number of problematic side effects. These include a risk for abuse, especially by those with histories of substance abuse; difficulties with cognition (thinking, learning and memory), including a type of amnesia that blocks the formation of new memories; and motor impairments that may make driving dangerous and contribute to falls among older adults. In addition, those who use benzodiazepine receptor agonists long-term may experience withdrawal symptoms—including anxiety, irritability and even seizures—if they stop taking the drugs. Ramelteon, a drug recently approved for treatment of insomnia, works through a different pathway in the brain involving melatonin receptors and therefore may be less likely to cause such effects.

Matthew W. Johnson, Ph.D., and colleagues at The Johns Hopkins School of Medicine, Baltimore, evaluated the potential for abuse and cognitive effects of ramelteon compared with placebo and with triazolam, a benzodiazepine, among 14 adults with histories of abusing sedatives. During approximately 18 days, participants stayed at a residential research unit and received one of the following doses of drugs each day in random order: 16, 80 or 160 milligrams of ramelteon (the recommended treatment dosage is 8 milligrams); .25, .5 or .75 milligrams of triazolam; and placebo. The patients, including one woman
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