Medication Show Medication SummaryMedications rarely are indicated for sleep terrors and usually provide no long-term help to patients. They should be prescribed only for severe symptoms that affect waking behavior (eg, school performance and peer or family relations) and only after behavioral interventions have failed. Pharmacologic therapy should be administered only as a temporary measure.  Tricyclic AntidepressantsClass SummaryTricyclic antidepressants decrease deep delta sleep and arousal between sleep stages. Imipramine (Tofranil, Tofranil-PM)
Imipramine hydrochloride inhibits reuptake of norepinephrine or serotonin at the presynaptic neuron. This agent is an antagonist at histamine H1 and alpha1 adrenoceptors, as well as at M2 muscarinic acetylcholine receptors. In limited studies, imipramine has stopped the disorder when administered at bedtime for 8 weeks. Amitriptyline
Amitriptyline is a tricyclic antidepressant (TCA) with sedative effects. It inhibits reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, which increases concentration in the central nervous system (CNS). Amitriptyline has been effective in the treatment of REM sleep disorder behaviors. BenzodiazepinesClass SummarySome studies suggest that long-term management with low dose clonazepam is effective for adults with severe sleep terrors involving violence or self-injurious behaviors. [28, 6] Clonazepam (Klonopin)
Long-acting benzodiazepine that increases the presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. It has been used off-label for REM and nonREM sleep behavior disorders. Antidepressants, selective serotonin reuptake inhibitors (SSRIs)Class SummarySSRIs are antidepressant agents that inhibit the central nervous system (CNS) neuronal uptake of serotonin and may also have a weak effect on norepinephrine and dopamine neuronal reuptake. SSRIs are used effectively to treat panic attacks. The overlap in symptoms between nocturnal panic attacks and night terrors could suggest a role for SSRIs in the treatment of night terrors. Paroxetine (Pexeva, Paxil, Paxil CR)
Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake, but it has a weak effect on norepinephrine and dopamine neuronal reuptake. This agent is a low-affinity antagonist at some subtypes of muscarinic acetylcholine receptors and is a nitric oxide synthase inhibitor. The anticholinergic effects of paroxetine may result in sedation or cardiovascular effects. Patients suffering from night terrors have been shown to respond to paroxetine therapy.
Author Eve G Spratt, MD, MSc Professor of Pediatrics and Psychiatry, Division of Developmental Pediatrics, Medical University of South Carolina; Director, Pediatric Consultation Liaison Psychiatry, Medical University of South Carolina Children's Hospital at Charleston Eve G Spratt, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry Disclosure: Nothing to disclose. Coauthor(s) Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Additional Contributors Martha Karlstad, MD Chief Resident, Child and Adolescent Psychiatry, Medical University of South Carolina College of Medicine Disclosure: Nothing to disclose. Katherine Harris, MD Medical University of South Carolina College of Medicine Katherine Harris, MD is a member of the following medical societies: American Medical Association Disclosure: Nothing to disclose. Acknowledgements Mark Anderson, MD Lt Col, United States Air Force, 75th Medical Squadron Disclosure: Nothing to disclose. Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association Disclosure: Nothing to disclose. Chet Johnson, MD Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose |
Low dose tricyclic antidepressants taken only at bedtime are routinely used for Quizlet
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