Cited by 178Sleep and related disordersSleep and Work-Related FatigueTraffic and Road Safety

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In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

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Gunja, Naren·2013·Journal of Medical Toxicology

DOI 10.1007/s13181-013-0294-yPMC PMC3657033

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Abstract

Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.

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Authors: Gunja, N.
Affiliations: Children's Hospital at Westmead (AU)
Corresponding author: Gunja, Naren
ORCID: Gunja, Naren
Venue: Journal of Medical Toxicology
Publisher: Springer Science and Business Media LLC
Published: 2013-03-02
Volume: 9
Issue: 2
Pages: 163-171
ISSN: 1556-9039 (ISSN-L)
1937-6995
DOI: 10.1007/s13181-013-0294-y
PMC: PMC3657033
OpenAlex: W1966792529
Cited by: 177
References: 85
Citations by year: 2026: 5 · 2025: 6 · 2024: 5 · 2023: 14 · 2022: 16 · 2021: 11 · 2020: 35 · 2019: 19 · 2018: 13 · 2017: 12 · 2016: 13 · 2015: 11 · 2014: 16 · 2013: 1
FWCI: 2.26
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Medical Toxicology (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
Keywords: Z-drugs, zolpidem, zopiclone, zaleplon, driving impairment, psychomotor performance, cognitive impairment, anterograde amnesia, sleepwalking, hallucinations, falls, hip fracture, traffic accidents, alcohol-drug interactions, insomnia treatment, elderly patients, benzodiazepine adverse effects, GABA agonists
MeSH terms: Zolpidem, Acetamides, Automobile Driving, Humans, Hypnotics and Sedatives, Piperazines, Psychomotor Disorders, Psychomotor Performance, Pyridines, Pyrimidines, Azabicyclo Compounds, GABA-A Receptor Agonists

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In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving

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