Sedatives
Sedatives are medications that depress the central nervous system, reducing alertness, anxiety, and agitation. At higher doses, sedatives induce sleep. The terms “sedative” and “hypnotic” are often used interchangeably — the distinction is primarily dose-dependent.
Drug Classes
The major sedative drug classes include:
- Benzodiazepines: Enhance GABA-A receptor activity; Schedule IV; rapid onset; flumazenil reversal agent (e.g., lorazepam, diazepam, midazolam)
- Nonbenzodiazepine Z-drugs: GABA-A agonists at different subunits; Schedule IV; Beers Criteria in older adults (e.g., zolpidem, eszopiclone, zaleplon)
- Melatonin receptor agonists: Not controlled; no dependence potential; preferred in older adults (ramelteon)
- Orexin receptor antagonists: Block wakefulness drive; Schedule IV (suvorexant, lemborexant)
Key Safety Points
- Fall risk: All sedative agents impair coordination, balance, and reaction time — implement fall precautions for all patients receiving sedatives
- CNS depression interactions: Sedatives + opioids or alcohol dramatically increase respiratory depression risk
- Beers Criteria: Benzodiazepines and Z-drugs are potentially inappropriate in older adults — increased fall, fracture, and cognitive impairment risk
- NEVER abrupt discontinuation of benzodiazepines — taper to prevent withdrawal seizures
Related Concepts
- sedative-hypnotics — Complete drug class overview with all agents, dosing, and nursing safety
- anxiolytics — Benzodiazepines used for anxiety; flumazenil reversal
- fall-prevention — Sedative-related fall risk assessment and prevention
- geriatric-assessment-and-polypharmacy-safety — Beers Criteria and sedatives in older adults
- psychotropic-medications — Overview of all psychiatric drug classes
See sedative-hypnotics for the complete drug class overview including mechanisms, adverse effects, nursing assessment, and patient education.